Execution
- 1Position the patient sitting with both wrists available for comparison.
- 2Flex the patient’s wrists maximally.
- 3Hold the wrists together in maximal flexion for 1 minute.
- 4Ask whether tingling, numbness, or paresthesia appears in the median nerve distribution.
- 5Stop the test early if familiar symptoms are clearly reproduced.
Positive outcome
Tingling or paresthesia into the thumb, index finger, middle finger, or lateral half of the ring finger is positive. Local wrist discomfort alone is not sufficient. Symptoms should match the patient’s familiar median nerve complaint.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| MacDermid & Wessel (2004) — systematic review | NA | 68 | 73 | 2.52 | 0.44 |
| Ahn (2001) | NA | 67.5 | 91.0 | 7.5 | 0.36 |
CommentMagee describes a 1-minute maximal wrist-flexion version. Evidence is mixed across reference standards, with systematic-review averages lower than some single diagnostic studies. Use Phalen as one CTS provocation test, not as a stand-alone diagnosis.
Moderate Clinical Value