Tinel's sign

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Tinel's sign
Carpal-Tunnel.svg
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, Physical medicine and rehabilitation, 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

This sign is commonly used in the evaluation of compression neuropathies, including carpal tunnel syndrome, cubital tunnel syndrome, [6] anterior tarsal tunnel syndrome [7] [8] and symptomatic neuroma. [9] It may also be used to monitor recovery following peripheral nerve injury or nerve repair.

Studies show that the diagnostic performance of Tinel’s sign varies substantially between populations and clinical settings, and it is generally interpreted alongside other physical examination findings and electrodiagnostic testing. [10] [11]

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] Tinel described the sign while studying peripheral nerve injuries in soldiers during World War I. He found that percussion over an injured nerve could produce tingling in the distal distribution of regenerating nerve fibers. [12]

German neurologist Paul Hoffmann independently also published an article on tinel sign six months earlier, in March 1915. [13] [12] 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." [12]

Technique

Clinical Use

Peripheral Nerve Injury and Regeneration

Diagnostic Accuracy

Limitations

See also

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{{citation}}: CS1 maint: work parameter with ISBN (link)
  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{{citation}}: CS1 maint: work parameter with ISBN (link)
  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{{citation}}: CS1 maint: work parameter with ISBN (link)
  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{{citation}}: CS1 maint: work parameter with ISBN (link)
  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{{citation}}: CS1 maint: work parameter with ISBN (link)
  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. ↑ Dabbagh, Armaghan; MacDermid, Joy C; Yong, Joshua; Packham, Tara L; Grewal, Ruby; Boutsikari, Eleni C (2023-06-05). "Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis". Physical Therapy. 103 (6). doi:10.1093/ptj/pzad029. ISSN   0031-9023. PMC   10294560 . PMID   37366626.
  11. ↑ Ozdag, Yagiz; Hu, Yirui; Hayes, Daniel S; Manzar, Shahid; Akoon, Anil; Klena, Joel C; Grandizio, Louis C (2023-07-24). "Sensitivity and Specificity of Examination Maneuvers for Carpal Tunnel Syndrome: A Meta-Analysis". Cureus. doi:10.7759/cureus.42383. ISSN   2168-8184. PMC   10446104 . PMID   37621797.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. 1 2 3 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.
  13. ↑ Wartenberg, Robert (June 1951). "Babinski Reflex and Marie-foix Flexor Withdrawal Reflex: Historical Notes" . A.M.A. 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.
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