Wrist Orthopaedic Test: Phalen’s Test

Phalen's test is a physical examination test used to diagnose carpal tunnel syndrome, which is a condition where there is compression of the median nerve in the wrist. The test is named after Dr. George S. Phalen, who first described it in 1951.

Procedure:

1. Ask the patient to sit comfortably with their forearms resting on a table or armrests of a chair.
2. Instruct the patient to flex their wrists, pressing the backs of their hands together, and keeping their elbows straight.
3. Hold this position for 60 seconds or until symptoms are reproduced.
4. Observe the patient's hands for any signs of numbness, tingling, or pain.
5. Ask the patient to report any sensations they experience during the test, such as numbness, tingling, or pain.
6. Repeat the test with the patient's wrists extended for 60 seconds.

A normal or negative result of the Phalen's test means that the patient does not experience any numbness, tingling, or pain in the median nerve distribution (thumb, index, middle, and radial half of the ring fingers) during or after the test.

The sensitivity and specificity of the Phalen's test can vary depending on the population being tested and the criteria used to define a positive result. However, in general, the Phalen's test has a sensitivity of around 75-80%, meaning that it correctly identifies carpal tunnel syndrome in about 75-80% of cases. The specificity of the test is lower, at around 50-60%, meaning that it may produce false-positive results (i.e., suggest carpal tunnel syndrome when it is not present) in some cases.

References:

1. Phalen, G. S. (1951). The carpal-tunnel syndrome. Clinical orthopaedics and related research, 2(2), 201-206.
2. Keith, M. W., & Masear, V. (2002). The diagnosis of carpal tunnel syndrome. The Journal of hand surgery, 27(3), 499-511.
3. Mondelli, M., Giannini, F., & Giacchi, M. (2003). Carpal tunnel syndrome incidence in a general population. Neurology, 61(12), 1545-1548.
4. Padua, L., Padua, R., & Nazzaro, M. (1997). Phalen's test in carpal tunnel syndrome. Lancet (London, England), 350(9090), 1269.