From the Research
The Phalen test is a useful diagnostic tool for identifying carpal tunnel syndrome, with moderate sensitivity, and should be used in conjunction with other clinical tests and nerve conduction studies to confirm the diagnosis. The test involves flexing both wrists fully for 60 seconds, with a positive result indicated by reproduction of symptoms such as numbness, tingling, or pain in the median nerve distribution 1. The Phalen test works by increasing pressure within the carpal tunnel, compressing the median nerve and reproducing symptoms in patients with carpal tunnel syndrome.
Key Points to Consider
- The Phalen test has moderate sensitivity, around 70-80%, but should be used alongside other clinical tests like Tinel's sign and direct compression tests for more accurate diagnosis 2.
- If the Phalen test is positive, further evaluation with nerve conduction studies may be warranted to confirm the diagnosis before proceeding with treatment options such as splinting, steroid injections, or surgical release 3.
- The test is more sensitive and specific for diagnosing tenosynovitis of the flexor muscles of the hand than for carpal tunnel syndrome itself 2.
- Remission of the Phalen test after surgical treatment is a favorable prognostic factor, with improved quality of life for patients with carpal tunnel syndrome 1.
Treatment Options
- Patients with mild to moderate carpal tunnel syndrome may be offered nonsurgical treatments, such as splinting or local corticosteroid injections 3.
- Patients with severe carpal tunnel syndrome, including objective weakness or sensory deficits, should be offered surgical decompression 3.
- Endoscopic and open carpal tunnel release techniques are equally effective, with similar outcomes at 5 years 4.