How to Perform Tinel's Sign
To perform Tinel's sign, lightly tap over the suspected nerve with your finger(s) to elicit a tingling sensation or paresthesia, which indicates nerve irritation or regeneration.
Technique Options
There are three main techniques for performing Tinel's sign:
- Single-finger strike: Use your dominant middle finger to tap over the nerve 1
- Double-finger strike: Use your dominant index and middle fingers together to tap over the nerve 1
- Preload technique: Place your non-dominant thumb over the nerve and strike it with your dominant middle finger 1
Proper Execution
When performing Tinel's sign:
- Position the patient comfortably with the area to be tested exposed 1
- Apply gentle to moderate percussion over the suspected nerve pathway 1
- Use consistent, controlled force (though research shows significant variability in force application between clinicians) 1
- A positive sign is indicated by the patient reporting tingling or electric shock-like sensations radiating distally in the distribution of the nerve being tested 2
Clinical Applications
Tinel's sign is commonly used for:
- Diagnosing compression neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome 2, 3
- Evaluating nerve regeneration after injury 4
- Assessing peripheral nerve pathology 2
Interpretation
- A positive Tinel's sign indicates nerve irritation or regeneration, not necessarily complete functional recovery 4
- The sign may be present in normal subjects without nerve pathology 3
- Sensitivity and specificity vary widely due to lack of standardization in technique 1
Common Pitfalls
- Inconsistent force application: Different examiners apply significantly different forces, affecting results 1
- Misinterpretation: A positive sign indicates nerve regeneration or irritation but does not predict complete functional recovery 4
- Lack of standardization: There is no universally accepted standard technique, which contributes to variability in results 1
- False positives: The sign may occasionally be present in normal subjects 3
Historical Context
- Although commonly called "Tinel's sign" after Jules Tinel, it was also contemporaneously described by Paul Hoffman in 1915 5
- Some sources refer to it as the "Hoffman-Tinel sign" to acknowledge both contributors 2
- The sign was originally described to monitor nerve regeneration after injury but has evolved to be used in diagnosing compression neuropathies 4