Execution
- 1Expose the volar wrist and identify the carpal tunnel region.
- 2Lightly tap or percusses over the median nerve at the wrist.
- 3Progress the percussion along the nerve course when monitoring regeneration.
- 4Ask whether tingling or paresthesia travels distal to the percussion site.
- 5Map whether symptoms enter the median nerve distribution.
Positive outcome
Tingling or paresthesia distal to the tapping point in the median nerve distribution is positive. Magee notes that the sensation must be distal to the point of pressure. A positive test supports median nerve irritability at the wrist but does not grade severity.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| MacDermid & Wessel (2004) — systematic review | NA | 50 | 77 | 2.17 | 0.65 |
| Ma & Kim (2012) | NA | 82.2 | 88.9 | 7.41 | 0.20 |
CommentTinel’s sign is specific when it reproduces classic distal median paresthesia, but sensitivity varies widely. It can also be used as a nerve-regeneration sign, which is a different clinical question from CTS diagnosis. Interpret it with symptom distribution, provocative tests, sensory testing, and electrodiagnosis when needed.
Moderate Clinical Value