Wrist Orthopaedic Test: Tinel’s Test

Tinel's test is a physical examination technique used to diagnose nerve compression or nerve injury. The test involves tapping or lightly pressing on a nerve to elicit a sensation of tingling, pins and needles, or numbness in the distribution of the nerve.

Tinel's test is most commonly used to assess for nerve compression in the upper extremities, such as carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. It can also be used to assess for nerve compression in the lower extremities, such as tarsal tunnel syndrome.

To perform Tinel's test, follow these steps:

1. Identify the location of the nerve suspected to be compressed or injured. For example, to test for carpal tunnel syndrome, locate the median nerve at the wrist crease.
2. Lightly tap or press along the course of the nerve with your fingers or a reflex hammer. Start proximally (closer to the spine) and move distally (towards the extremity).
3. Ask the patient if they feel any sensation such as tingling, pins and needles, or numbness in the distribution of the nerve. If the patient reports feeling these sensations, it may indicate nerve compression or injury.
4. Repeat the test at least three times to ensure accuracy.

In general, Tinel's test has a sensitivity of around 60-70% and a specificity of around 80-90% for diagnosing carpal tunnel syndrome. However, the accuracy of the test can be affected by a number of factors, including the severity of the nerve compression or injury, the location of the compression or injury, and the experience of the examiner performing the test.

References:

1. Tinel J. Le signe du fourmillement dans les lesions des nerfs peripheriques. Presse Med. 1915;23:389-391. (Original French article describing Tinel's test)
2. Katz JN, Simmons BP. Carpal tunnel syndrome. N Engl J Med. 2002;346(23):1807-1812. doi: 10.1056/NEJMcp013018. (Review article discussing the diagnosis of carpal tunnel syndrome, including Tinel's test)
3. Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006;31(6):919-924. doi: 10.1016/j.jhsa.2006.03.006. (Study evaluating the sensitivity and specificity of Tinel's test for diagnosing carpal tunnel syndrome)
4. Cuccurullo SJ. Physical Medicine and Rehabilitation Board Review. Demos Medical Publishing; 2014. (Textbook discussing Tinel's test and other physical examination techniques used in the diagnosis of nerve injuries)