Tinel’s Test Definition
Tinel’s test is a provocative test in which tapping (percussing) over the damaged nerve triggers paresthesia (tingling or electric shock-like sensation) distally from the tapping site.
How is Tinel’s test performed?
Picture 1. The Tinel’s test should start with slight tapping
followed by harder tapping at the typical sites for the particular nerve.
NOTE: Excessively hard tapping may trigger symptoms even in a healthy nerve.
(free image use)
What does positive Tinel’s sign mean?
Tinel’s sign is positive when tapping over the nerve results in paresthesia (tingling, pins and needles, electric-shock sensations) in the distribution of the nerve distally from the point of tapping 5. Tingling is a sign of nerve regeneration (recovery) after a nerve injury or compression 1.
When is the sign negative?
Tinel’s sign is negative or absent 2:
- When the nerve is not injured (enough)
- When only the myelin sheath of the nerve is damaged (demyelination), but the nerve axon remains intact (this is called a first-degree nerve injury or neurapraxia).
Shoulder – Brachial Plexus
Video 1. A demonstration of the Tinel’s test for the brachial plexus.
Tingling or pain in the arm during tapping the area above the clavicle
(between the shoulder and the neck) suggests a damage of the brachial plexus.
Elbow and Wrist – Ulnar, Median and Radial Nerve
Video 2. Demonstration of the Tinel’s test for
the ulnar, median and radial nerve in the elbow, forearm and wrist.
- Tapping over the ulnar nerve in the cubital tunnel in the elbow can produce symptoms typical for cubital tunnel syndrome (pain and tingling in the forearm, ulnar-palmar side of the wrist and hand and in pinky and ring finger).
- Tapping over the ulnar nerve in the ulnar-palmar side of the wrist can produce symptoms of Guyon’s canal syndrome (tingling in the 5th and 4th finger).
- Tapping over the median nerve at the center of the palmar side of the wrist can produce symptoms of carpal tunnel syndrome (tingling in the thumb, index, middle and ring finger).
- Tapping over the radial nerve at the radial-back side of the wrist can produce symptoms distally from the tapping (radial-back side of the hand).
The knee – Common Fibular (Peroneal) Nerve
Video 3. Demonstration of the Tinel’s test for the peroneal nerve.
Tingling or pain in the lateral side of the lower leg
during tapping over the fibular head on the lateral side of the knee
suggests a damage of the peroneal nerve.
The Medial Ankle – Posterior Tibial Nerve
Video 4. Demonstration of the Tinel’s test for the posterior tibial nerve.
Tingling in the sole (including the heel), big toe and the next three toes
during tapping behind and under the medial ankle
suggests tarsal tunnel syndrome 3,6.
Moving Tinel’s Sign
Meaning of the moving Tinel’s sign: Tingling upon tapping moves distally (toward the ends of the limbs) over time: 2
- When only the nerve axon but no surrounding tissues are injured (axonotmesis)
- In a third-degree nerve injury.
Stationary Tinel’s Sign
Meaning: tingling upon tapping does not move further over time: 2
- In a fourth-degree nerve injury (scarring of the surrounding tissues prevents nerve recovery)
- In a fifth-degree nerve injury, when the nerve is cut (neurotmesis)
- In a sixth-degree nerve injury (a combination of various nerve injuries).
Proximal or Reverse Tinel’s Sign in Neuroma
In individuals with a nerve tumor (neuroma), tapping over the neuroma triggers strong pain, and tapping within few inches proximally of the neuroma (toward the body) triggers a weak pain 2. For example, pain during tapping over the front side of the foot between the 3rd and 4th toe suggests Morton’s neuroma.
- Back of the head (to check for occipital neuralgia) 8
- Perineum, in the pudendal nerve canal (to check for pudendal neuralgia) 7
- Inguinal ligament, over the femoral nerve (to check for femoral neuropathy, meralgia paresthetica) 9,10
- Behind and below the lateral ankle, over the sural nerve (short saphenous nerve).
Sensitivity and Specificity
According to various studies 1:
- Sensitivity of the Tinel’s sign in diagnosing carpal tunnel syndrome is 25-75% (only in this percent of individuals with carpal tunnel syndrome, the test is positive)
- Specificity of the Tinel’s sign in carpal tunnel syndrome is 70-90% (only this percent of individuals who have positive Tinel’s sign actually has carpal tunnel syndrome).
Who named it?
Tinel’s sign has got name after Jules Tinel (1879-1952), a French neurologist 4.
- Turner-white.com (Tinel’s and Phalen’s sign definition)
- Wustl.edu (Types)
- PubMed (Tarsal tunnel syndrome)
- Whonamedit.com (Jules Tinel)
- FPnotebook.com (Tinel’s sign)
- PubMed (The tibial nerve in diabetic neuropathy)
- Oswego.edu (Pudendal neuralgia)
- Pain-consultant.co.uk (Occipital neuralgia)
- PMC (Femoral mononeuropathy)
- Cns.org (Diagnosis and management of peripheral nerve entrapment)