Tinel's sign

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Tinel's sign
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Transverse section across the wrist and digits. (The median nerve is the yellow dot near the center. The carpal tunnel is not labeled, but the circular structure surrounding the median nerve is visible.)
Tinel's sign.jpg
A photograph conveying Tinel's sign being performed on the left foot to support the diagnosis of morton's neuroma.
Specialty Neurology, Plastic surgery
Differential diagnosis Peripheral neuropathy, Radiculopathy, Plexopathy

Tinel's sign (also Hoffmann-Tinel sign) is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. [1] [2] Percussion is usually performed moving distal to proximal. [2] It is named after Jules Tinel. [3] [4] [5]

Contents

It is a potential sign of carpal tunnel syndrome, cubital tunnel syndrome, [6] anterior tarsal tunnel syndrome [7] [8] and symptomatic neuroma. [9]

History

Tinel's sign takes its name from French neurologist Jules Tinel (1879–1952), who wrote about it in a journal article published in October 1915. [3] [4] [5] German neurologist Paul Hoffmann independently also published an article on the sign six months earlier, in March 1915. [10] [11] Previously, in 1909, Trotter and Davies published their findings that sensations elicited distal to the point of nerve resection are referred to the area or point of nerve resection; however they "failed to comment on the clinical relevance of their observation." [11]

See also

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<span class="mw-page-title-main">Jules Tinel</span> French neurologist (1879–1952)

Jules Tinel was a French neurologist remembered for describing Tinel's sign.

<span class="mw-page-title-main">Nerve compression syndrome</span> Human disease

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

Paul Hoffmann was a German neurophysiologist, chiefly known for describing Hoffmann's sign.

References

  1. ↑ Gujar, Bansari; Flores, Raymond H. (2015-01-01), Hochberg, Marc C.; Silman, Alan J.; Smolen, Josef S.; Weinblatt, Michael E. (eds.), "81 - Entrapment neuropathies and compartment syndromes", Rheumatology (Sixth Edition), Philadelphia: Content Repository Only!, pp. 671–682, ISBN   978-0-323-09138-1 , retrieved 2020-10-29
  2. 1 2 Lim, Aymeric Y. T.; Sebastin, Sandeep J. (2012-01-01), Chung, Kevin C.; Yang, Lynda J. -S.; McGillicuddy, John E. (eds.), "CHAPTER 14 - Clinical examination and diagnosis", Practical Management of Pediatric and Adult Brachial Plexus Palsies, Philadelphia: W.B. Saunders, pp. 173–197, doi:10.1016/b978-1-4377-0575-1.00014-9, ISBN   978-1-4377-0575-1 , retrieved 2020-10-29
  3. 1 2 Tinel, J. (1978) The "tingling sign" in peripheral nerve lesions (Translated by EB Kaplan). In: M. Spinner M (Ed.), Injuries to the Ma jor Branches of Peripheral Nerves of the Forearm. (2nd ed.) (pp 8–13). Philadelphia: WD Saunders Co
  4. 1 2 Tinel, J. (1915) Le signe du fourmillement dans les lésions des nerfs périphériques. Presse médicale, 47, 388–389
  5. 1 2 Tinel, J., Nerve wounds. London: Baillère, Tindall and Cox, 1917
  6. ↑ Waldman, Steven D.; Campbell, Robert S. D., eds. (2011-01-01), "CHAPTER 114 - Cubital Tunnel Syndrome", Imaging of Pain, Philadelphia: W.B. Saunders: 289–290, doi:10.1016/b978-1-4377-0906-3.00114-0, ISBN   978-1-4377-0906-3 , retrieved 2020-10-29
  7. ↑ Waldman, Steven D.; Campbell, Robert S. D., eds. (2011-01-01), "CHAPTER 164 - Anterior Tarsal Tunnel Syndrome", Imaging of Pain, Philadelphia: W.B. Saunders: 421–423, doi:10.1016/b978-1-4377-0906-3.00164-4, ISBN   978-1-4377-0906-3 , retrieved 2020-10-29
  8. ↑ Stephen, David J. G.; Choy, Gregory W.; Fam, Adel G. (2010-01-01), Lawry, George V.; Kreder, Hans J.; Hawker, Gillian A.; Jerome, Dana (eds.), "The Ankle and Foot", Fam's Musculoskeletal Examination and Joint Injection Techniques (Second Edition), Philadelphia: Mosby, pp. 89–101, doi:10.1016/b978-0-323-06504-7.10007-7, ISBN   978-0-323-06504-7 , retrieved 2020-10-29
  9. ↑ Wolvetang, Nicolaas H. A.; Lans, Jonathan; Verhiel, Svenna H. W. L.; Notermans, Bo J. W.; Chen, Neal C.; Eberlin, Kyle R. (June 2019). "Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery". Plastic and Reconstructive Surgery. 143 (6): 1762–1771. doi: 10.1097/PRS.0000000000005664 . ISSN   0032-1052. PMID   30907815.
  10. ↑ Wartenberg, Robert (June 1951). "Babinski Reflex and Marie-foix Flexor Withdrawal Reflex: Historical Notes". AMA Archives of Neurology & Psychiatry. 55 (6): 713–716. doi:10.1001/archneurpsyc.1951.02320060056006. PMID   14829100 . Retrieved January 24, 2021. The very same phenomenon, however, had been described by Paul Hoffmann in a German medical periodical in the issue of March 28 of the same year. The Germans, therefore, speak of the Hoffmann-Tinel sign.
  11. 1 2 Sansone, Jason M.; Gatzke, Angela M.; Aslinia, Florence; Rolak, Loren A.; Yale, Steven H. (March 2006). "Jules Tinel (1879-1952) and Paul Hoffmann (1884-1962)". Clinical Medicine & Research. 4 (1): 85–89. doi:10.3121/cmr.4.1.85. PMC   1435662 . PMID   16718952. Dr. Paul Hoffmann described the sign in March of 1915 in On a Method of Evaluating the Success of a Nerve Suture. Several months later in October 1915, Dr. Jules Tinel published his work on the sign in The Sign of Tingling in Lesions of Peripheral Nerves.
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