Execution
- 1Confirm that the patient currently has paresthesia in the hand in a median nerve distribution.
- 2Ask the patient to vigorously shake the hands or flick the wrists as they would to relieve symptoms.
- 3Observe the motion and ensure it is a symptom-relief maneuver rather than a strength test.
- 4Ask whether symptoms resolve or clearly decrease after flicking.
- 5Record whether the patient reports this same behavior during daily or night symptoms.
Positive outcome
Resolution or clear relief of median nerve paresthesia after shaking or flicking the wrist is positive. The sign is history-dependent and is strongest when the patient spontaneously reports it as a habitual relief strategy.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Pryse-Phillips (1984) | NA | 93 | 95 | 18.6 | 0.07 |
| Hansen et al. (2004) | NA | NA | NA | NA | NA |
CommentThe original Pryse-Phillips report was very strong, but later work questioned reproducibility and clinical utility. Magee presents it as a symptom-relief sign rather than a provocation test. Treat a classic flick sign as supportive, not conclusive, especially if symptoms are not clearly median-nerve distributed.
Moderate Clinical Value