Tinel’s Test

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Published: September 26, 2013
Last reviewed: June 15, 2017

Tinel’s Test Definition

Tinel’s test is a provocative test in which tapping over the damaged nerve triggers tingling or electric shock-like sensation (paresthesia) distally from the tapping site.

How is Tinel’s test performed?

Tinel's Sign Picture

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.

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. A 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. A 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. A 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.

Tinel’s Test On Other Sites

  • Back of the head (to check for occipital neuralgia)
  • 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) 8,9
  • 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 the name after Jules Tinel (1879-1952), a French neurologist 4.

References:

  1. Turner-white.com  (Tinel’s and Phalen’s sign definition)
  2. Wustl.edu  (Types)
  3. PubMed  (Tarsal tunnel syndrome)
  4. Whonamedit.com  (Jules Tinel)
  5. FPnotebook.com  (Tinel’s sign)
  6. PubMed  (The tibial nerve in diabetic neuropathy)
  7. Oswego.edu  (Pudendal neuralgia)
  8. Cns.org  (Diagnosis and management of peripheral nerve entrapment)
  9. PMC  (Femoral mononeuropathy)

18 Responses to Tinel’s Test

  1. Stephanie says:

    How common is there a negative Tinel test with tarsal tunnel or Baxter’s nerve entrapment?
    Symptoms and EMG/NSC point that direction but negative Tinel sign.
    Dr. is recommending tarsal tunnel release. Is it possible the entrapment is elsewhere in that area so not responsive to Tinel test?

  2. Elaine Snyder says:

    Does a positive Tinel’s over the sural nerve rule out the back as the source of heel pain?

    • Jan Modric says:

      Elaine, I believe that Tinel at the heel would be positive in sural nerve damage but not in a pinched nerve root in the lumbar spine. I conclude this from this source (Wheeles Online), which describes a similar situation in cervical radiculopathy:

      In radiculopathy, direct palpation or percussion over the exiting nerve root may provoke the patient’s familiar limb or axial pain; if the tenderness or a Tinel’s sign is elicited more laterally, such as in the supraclavicular fossa, then the diagnosis should be questioned.

      To be exact, positive Tinel at the heel does not automatically “rule out” a pinched nerve in the back, because this could co-exist with a sural nerve damage. But a pinched nerve in the back alone would not make Tinel’s test in the calf positive.

  3. Kaitlyn Kiste says:

    I have occipital neuralgia and the doctor told me that my tinel’s sign is positive, what is the best way to treat this?

    • Jan Modric says:

      Kaitlyn, it would be good to know what causes the neuralgia – it could be a spinal-cord related issue, but a doctor can tell.

  4. vipin says:

    how long does it usually take for a compressed nerve to return to normal. I have food drop due to compartment syndrome. I feel an electric shock in feet when i tap the nerve where compartment syndrome happened (muscle below knee). is this a healing sign?

    • Jan Modric says:

      vipin, electric shock may or may not be a healing sign. If the underlying cause was removed, the nerve is probably healing. The doctor who treated you may know better about the heeling time: probably weeks or, to complete normal, probably months.

  5. Chantelle Mattox says:

    I recently had pretty extensive surgery on my left foot. Had a partial plantar fascia release, tarsal tunnel release, & partial Achilles tendon release…. It has been about 2 1/2 maths since surgery and now I’m experiencing sharp stabbing pain on outside of heel/ankle, numbness across 3/4 of top of my foot into big toe & 2nd toe. There is always tingling and burning sensation.. Just the slightest rub or even water from shower is almost unbearable.. Dr’s are at a loss. Please give me some direction

    • Jan Modric says:

      Chantelle, tingling and burning suggests the nerve involvement. This could possibly happen due to development of internal scars (adhesions). I suggest you to contact the surgeon who operated you.

  6. lance says:

    If a patient has a positive tinel’s sign that extends all the way to the distal end of a limb does it mean that the nerve is intact? For example, percussion over the fibular head elicits a tingling in the dorsum of foot in the face of a foot drop.

  7. narendran says:

    what are the reasons for negative tinel sign

    • Jan Modric says:

      Tinel’s test may be negative in demyelinating diseases in which only the myelin sheath of the nerve is affected, for example in multiple sclerosis.

  8. faheem says:

    Can there be a positive tinel’s sign few months after the excision of radial nerve schwannoma of arm..

    • Staff says:

      It could be possible; it could be also from the schwannoma regrowth or some surgery complication, so if in doubt, please contact your doctor.

  9. Do not provide misinformation about Tinel’s sign being positive for tingling or pain. The original description of Tinel is paresthesias only. Pain is not a positive Tinel’s sign. Please adjust your description to include tingling as the only positive Tinel’s. Pain is indicative of a negative Tinel’s sign. Please review the historical review of Tinel’s here:
    http://www.turner-white.com/pdf/hp_jul00_tinel.pdf

    • Staff says:

      Dr. Sollender, I have the link you provided as the 1st reference and, yes, that page mentions only tingling and that “true Tinel’s sign is never painful”.

      My explanation is that Tinel *test*, which now simply means tapping over the nerve, can produce pain, for example in neuroma, but Tinel used the Tinel’s *sign* as the description for only nerve regeneration, which, as I understand, involves only tingling. I edited the article above accordingly. Tapping over the damaged nerve can also produce pain in femoral mononeuropathy, so I do not agree that pain makes the Tinel sign negative. The question is what is considered *true* Tinel sign and what not. Tapping over the damaged nerve certainly can trigger pain as described here in the evaluation of the median nerve damage in carpal tunnel syndrome: “Tinel sign (localized pain or paresthesia in the cutaneous distribution of the nerve when it is percussed).”

      I appreciate your comment.

      Jan Modric

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