[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) › Phalen and Tinel signs [Clinical exam](https://durgical.com/en/clinical-exam/) · [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) # Phalen and Tinel signs - Maneuver Two simple wrist maneuvers that bring on tingling in the fingers when the median nerve is squeezed in the carpal tunnel. Updated 2026-11-01 **See it in 3D:** [Median nerve](https://durgical.com/en/anatomy/median-nerve/) · [Carpal tunnel](https://durgical.com/en/anatomy/carpal-tunnel/) · [Flexor retinaculum](https://durgical.com/en/anatomy/flexor-retinaculum/) · [APB](https://durgical.com/en/anatomy/abductor-pollicis-brevis/) · [Recurrent motor branch](https://durgical.com/en/anatomy/recurrent-motor-branch-of-the-median-nerve/) · [Palmar cutaneous branch](https://durgical.com/en/anatomy/palmar-cutaneous-branch-of-the-median-nerve/) ## Key points - Phalen: full flexion of both wrists for 60 seconds; positive if paresthesias appear in the median nerve territory. - Tinel: tapping over the median nerve at the palmar wrist; positive if tingling shoots into the fingers. - Median sensory territory: palmar side of the thumb, index, middle finger and radial half of the ring finger. - The thenar palm keeps its sensation because the palmar cutaneous branch of the median nerve does not run through the tunnel. - Neither test is enough alone; thenar wasting helps rule in and electrodiagnosis is the reference. ## What it is The Phalen maneuver (sustained wrist flexion) and the Tinel sign (tapping over the nerve) try to reproduce the paresthesias of carpal tunnel syndrome, the most common entrapment neuropathy. They are quick and can be done in any clinic, but their accuracy is limited: they point the way, and the diagnosis is confirmed with the full clinical picture and nerve conduction studies. ## The anatomy it tests - The carpal tunnel is a channel between the carpal bones and the flexor retinaculum; the median nerve and nine flexor tendons pass through it. - Forced wrist flexion raises the pressure inside the tunnel and compresses the nerve (Phalen); tapping fires irritated sensory fibres (Tinel). - The palmar cutaneous branch of the median nerve leaves before the tunnel and runs over the retinaculum, so palm sensation is usually spared. - The recurrent motor branch supplies the thenar muscles, including abductor pollicis brevis. ## How to do it - Phalen: patient seated; ask them to flex both wrists fully and press the backs of the hands together, fingers pointing down. - Hold the position for up to 60 seconds and ask whether tingling or numbness appears, and in which fingers. - Positive Phalen: paresthesias in the thumb, index, middle and radial half of the ring finger within that minute. - Tinel: forearm resting palm up with the wrist slightly extended. - The examiner taps with a fingertip or a reflex hammer over the course of the median nerve at the palmar wrist crease. - Positive Tinel: an electric or tingling feeling that shoots into the median nerve fingers. - Finish with fingertip sensation, a look at the thenar eminence and thumb abduction against resistance. ## What a positive result means - A positive Phalen or Tinel supports carpal tunnel syndrome: compression of the median nerve at the wrist. - Typical story: night-time tingling that wakes the patient and eases by shaking the hand, in the first three and a half fingers. - Thenar wasting and weak thumb abduction: motor involvement, more advanced disease. - Associated settings: pregnancy, hypothyroidism, diabetes, rheumatoid arthritis and repetitive manual work. - A negative Phalen or Tinel does not rule the syndrome out. - The Tinel sign is also used on other nerves (ulnar at the elbow, tibial at the ankle) and to follow regrowth of an injured nerve. ## Usefulness and limits - Both tests have limited accuracy: a single result neither confirms nor excludes the syndrome. - Thenar wasting helps rule in; nerve conduction studies and electromyography confirm and grade the lesion. - The result depends on how the sensation is explained and how hard the tap is. ## Memory aid Phalen folds, Tinel taps: both wake up a sleeping median nerve. ## Test yourself Think of the answer, then tap the question to see it. ## How is the Phalen maneuver done? Both wrists are fully flexed with the backs of the hands pressed together for about 60 seconds; it is positive if paresthesias appear in the median nerve territory. ## Which fingers are affected in carpal tunnel syndrome? On the palmar side: the thumb, index, middle finger and radial half of the ring finger. ## Why is sensation over the thenar eminence usually preserved in carpal tunnel syndrome? Because the palmar cutaneous branch of the median nerve leaves before the tunnel and runs over the flexor retinaculum. ## Which muscle is tested to detect median motor involvement in the hand? Abductor pollicis brevis, by asking the patient to abduct the thumb against resistance, at right angles to the palm. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/phalen-and-tinel-signs/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Median nerve](https://durgical.com/en/anatomy/median-nerve/) - [Carpal tunnel](https://durgical.com/en/anatomy/carpal-tunnel/) - [Flexor retinaculum](https://durgical.com/en/anatomy/flexor-retinaculum/) - [APB](https://durgical.com/en/anatomy/abductor-pollicis-brevis/) - [Recurrent motor branch](https://durgical.com/en/anatomy/recurrent-motor-branch-of-the-median-nerve/) - [Palmar cutaneous branch](https://durgical.com/en/anatomy/palmar-cutaneous-branch-of-the-median-nerve/) ## Related - [Finkelstein test](https://durgical.com/en/clinical-exam/finkelstein-test/) - [Sensory examination: modalities and dermatomes](https://durgical.com/en/clinical-exam/sensory-examination-modalities-and-dermatomes/) - [Motor examination: bulk, tone and strength grading](https://durgical.com/en/clinical-exam/motor-examination-bulk-tone-and-strength-grading/) - [Joint examination: inspection, palpation and range of motion](https://durgical.com/en/clinical-exam/joint-examination-inspection-palpation-and-range-of-motion/) ## Related conditions - [Carpal tunnel syndrome](https://durgical.com/en/conditions/carpal-tunnel-syndrome/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Carpal Tunnel Syndrome](https://aafp.org/pubs/afp/issues/2024/0600/pocg-carpal-tunnel-syndrome.html) (American Family Physician (American Academy of Family Physicians), 2024); [Musculo-Skeletal Examination – Hand Exam – Practical Guide to Clinical Medicine](https://sites.ucsd.edu/clinicalmedguide/musculo-skeletal-examination-hand-exam/) (UC San Diego School of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/phalen-and-tinel-signs/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/phalen-and-tinel-signs/