Tinel Sign | Carpal Tunnel Syndrome Test

Tinel sign is another form of clinical test conducted to determine patients with irritated or compressed nerves. The study is especially beneficial in cases of carpal tunnel syndrome, cubital tunnel syndrome, and any other peripheral neuropathy. The test is in fact called Tinel of Hammersop or Jules Tinel in homage to the neurologist French who made known the test, at the beginning of the XX th century.

Indication for the Test

The Tinel Sign is indicated for patients who present with symptoms suggestive of nerve irritation or compression, such as:

• ‘Paresthesia 'or ‘numbness’ more specifically described as tingling or ‘pins and needles’ sensations.
• Tingling or a sensation of pins and needles in the area supplied by a particular nerve.
• Pain that spreads out from the point on the skin affected by the nerve.
• Muscle atrophy in the area, where the nerve is damaged as well as the inability to contract muscles controlled by the affected nerve.

How to Perform the Tinel Sign

To perform the Tinel Sign, the physiotherapist follows these steps:

• Positioning: The patient is either seated or reclined in a position that will not cause any discomfort throughout The assessment.
• Starting Position: The physiotherapist then locates the nerve to be tested and the zone in which it will probably be groped or pinched.
• Percussion: The physiotherapist then places their fingers or a reflex hammer on the skin over the nerve and then taps it light.

Assessment Outcomes of Tinel Sign

• Positive Test: The patient complain tingling, pain or the sensation of ‘pins and needles along the distribution of the nerve that is being tested due to irritation or compression. This is positive tinel sign.
• Negative Test: The patient is not having any tingling sensation or any discomfort which indicates that there is no much irritation or compression of the nerves.

Differential Diagnosis with Tinel Sign

The Tinel Sign is useful for differentiating nerve irritation or compression from other conditions, such as:

• Tendonitis or tenosynovitis.
• Arthritis or joint inflammation.
• Muscle strain or sprain.
• Vascular insufficiency.
• Central nervous system disorders.

Related Tests of Tinel Sign

• Hoffman’s Tinel’s (For Carpal Tunnel Syndrome)
• The second of these tests is Durkan’s Compression Test, which is specifically performed when there are preliminary symptoms of carpal tunnel syndrome.
• Froment’s Sign is the claw-like inability to flex the terminal phalanges of the first ray when the thumb is flat on the palm.
• Elbow flexion test is a confirmatory test done for cubital tunnel syndrome to confirm the diagnosis made from a positive Tinel’s sign test.

Evidence-Based Physiotherapy

Postoperative patients confirm the Tinel Sign as a reliable tool in aid of the clinical examination in assessment of nerve irritation or compression. This test can then be accompanied by other clinical tests like nerve conduction studies or electromyography (EMG) to improve the extent of efficiency of the diagnosis.

Research in physiotherapy in the future may include improved diagnostic methodologies, imaging techniques, and interventions for nerve compression syndromes. The literature also focuses on specific exercise programs, which are developed for every patient and aim at restoring nerve sliding, atraumatic splinting/brace wearing, manual therapy, and patient counseling regarding activity and prevention.

In turn, findings of recent studies that physiotherapy should be administered in the early stages of the disease contribute to patients with nerve compression syndromes. Conservative therapy, including specific electric exercising regimen, can help to improve the quality of life and avoid the relapses. For chronic or severe cases, there are surgery options available for those that are willing to undergo the procedure. Further studies are needed to set up more protocols of clinical practice and guidelines of conservative and surgical intervention with better results in patients’ treatment.