Elbow Orthopaedic Test: Tinel’s Test

Tinel's Test is a physical examination maneuver used to assess for the presence of compression neuropathy. The test involves tapping or percussing along a nerve pathway to elicit a sensation of tingling or pins and needles in the distribution of the nerve. The test is named after French neurologist Jules Tinel, who first described the technique in 1915.

Procedure:

1. Position the patient comfortably so that the area to be tested is easily accessible and visible.
2. Identify the location of the nerve along its course. For example, for carpal tunnel syndrome, the median nerve is located at the wrist.
3. Gently tap along the nerve pathway with your finger or a reflex hammer, starting from a distal location and moving proximally. The tapping should be firm enough to elicit a sensation but not so forceful as to cause pain.
4. Ask the patient to report any sensations they experience during the tapping, such as tingling or pins and needles. You can also observe the patient for any signs of discomfort or involuntary movements.
5. Repeat the test in different locations along the nerve pathway as necessary to thoroughly evaluate the nerve.

A positive test is characterized by the patient experiencing a sensation of tingling or pins and needles in the distribution of the nerve.

There is no specific "normal" result for Tinel's Test, as the purpose of the test is to elicit a response that can aid in the diagnosis of nerve compression or injury.

Regarding the sensitivity and specificity of Tinel's Test, the available evidence suggests that it has moderate sensitivity and high specificity for detecting nerve compression. Sensitivity refers to the proportion of true positives (people with the condition who test positive) and specificity refers to the proportion of true negatives (people without the condition who test negative).

References:

1. Prakash Nagarkatti G, Selvam V, Nagarajan R. Tinel's sign. J Neurosci Rural Pract. 2012;3(4):475-476. doi: 10.4103/0976-3147.102620
2. Westermann GW, Machens HG, Schaller HE. Tinel's sign--a useful tool for the bedside diagnosis of compressive neuropathies: a critical reappraisal. J Reconstr Microsurg. 2001;17(8):589-596. doi: 10.1055/s-2001-18870
3. Dellon AL. Tinel's sign and the potential role of regenerative neuroplasty. J Hand Surg Am. 2010;35(9):1530-1532. doi: 10.1016/j.jhsa.2010.06.016