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What Is a Tinel Sign?

Medically Reviewed by Dan Brennan, MD on June 16, 2021

The Tinel sign test dates back to 1915 and is used to check for nerve problems called neuropathies. Experts disagree about how well the test works.

Tinel Sign and Nerves

The Tinel sign is the result of a simple, noninvasive test that checks for nerve problems. It involves tapping a finger along the problem nerve, which can produce tingling or pain. This sensation is a sign of nerve damage and is called the Tinel sign. 

The Tinel sign test is used with imaging tests to find compressed or squeezed nerves and nerve regrowth. It’s often used to diagnose carpal tunnel syndrome, a condition caused by compression in the nerve in your wrist. Symptoms can include:

  • Numbness
  • Tingling
  • Pain in your wrist and hand
  • Pain radiating into your forearm, elbow, and shoulder

The Tinel sign is a general sign for nerve damage and can show other nerve problems such as:

  • Cubital tunnel syndrome — inflammation in the nerve in your elbow, causing pain, like when you hit your funny bone
  • Tarsal tunnel syndrome — when the nerve from inside the ankle into the foot becomes squeezed
  • Guyon’s canal syndrome — compression of your ulnar nerve that goes from your wrist into your hand
  • Sciatica — compression of a lumbar nerve from a slipped disk that causes lower back pain

Some experts feel the Tinel sign can’t diagnose a nerve condition because other factors may influence the results. So other tests must be done.

Tinel Sign Test Results

A positive Tinel sign means that tapping your nerve causes a tingling sensation to radiate through that area of your body. It’s sometimes described as a pins and needles feeling. 

The Tinel sign shows there's damage in the nerve. Your doctor will keep doing the test over time to monitor how, or if, the nerve is regenerating.

This damage can be caused by:

A normal test result means you don't have a tingling sensation when your nerve is tapped. This is sometimes called a negative Tinel sign. But a negative Tinel sign doesn’t always mean everything is normal. It can mean the nerve isn’t regrowing after an injury. Your doctor will do some more tests, especially if you have other symptoms. These symptoms can include:

Limitations of the Tinel Sign

Results can vary based on the amount of pressure used on your wrist. If your doctor taps too hard or sharply, you will have tingling even if there isn’t a problem. 

The Tinel sign isn’t always effective. In cases such as carpal tunnel syndrome, other nerves in the area will continually grow. If your doctor is using the Tinel sign to check for nerve regrowth and change, it could be mistaken for these nerves. 

Tinel sign accuracy is also mixed. One review said that people with carpal tunnel syndrome had a positive Tinel sign from 8% to 100% of cases. Another study says the Tinel sign is the least accurate test for diagnosing carpal tunnel syndrome. 

The difference in technique and pressure when doing the Tinel sign test leads to some of the mixed results.

Other Tests

Since the Tinel sign isn’t a complete diagnosis, your doctor will do some other tests. 

Phalen test. This test looks for nerve compression when you bend your wrist or ankle. For carpal tunnel syndrome, you sit with your elbows on the table and your hands raised in the air, then you let your hands fall naturally in towards each other. A positive Phalen test happens when you have numbness, tingling, or pain within one minute.

Nerve conduction velocity test. This test is done by stimulating your nerves with an electrode and measuring the speed of the stimulation across your nerve. Any areas where the electrical signal slows down or doesn’t reach can show where there’s damage. 

Ultrasound. If your doctor suspects there’s some damage in your nerves, they might take an ultrasound of the area. This can help find any growths on the nerves and also help with medicine injections into the nerve. 

Considerations for Tinel Sign

The Tinel sign is an old test that doctors have used for a long time as part of physical examination. To confirm diagnosis of a nerve problem, other tests need to be done. 

WebMD Medical Reference

Sources

SOURCES:

Aleksenko, D., Varacallo, M. Guyon’s Canal Syndrome, StatPearls Publishing, 2021.

American College of Foot and Ankle Surgeons Foot Health Facts: “Tarsal Tunnel Syndrome.”

Cedars Sinai: “Cubital Tunnel Syndrome.”

Clinical Neurology and Neurosurgery: “Provocative tests in different stages of carpal tunnel syndrome.”

Ho, T., Braza, M., Hoffman Tinel Sign, StatPearls Publishing, 2021.

Medscape: “Carpal Tunnel Syndrome.”

Pain Reports: “Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management.”

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