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.) | |
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]
It is a potential sign of carpal tunnel syndrome, cubital tunnel syndrome, [6] anterior tarsal tunnel syndrome [7] [8] and symptomatic neuroma. [9]
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 tinel 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]
A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, repetitive stress disorders, cumulative trauma disorders (CTDs), and overuse syndrome.
The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.
The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.
The ulnar nerve is a nerve that runs near the ulna, one of the two long bones in the forearm. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.
The dorsal scapular nerve is a branch of the brachial plexus, usually derived from the ventral ramus of cervical nerve C5. It provides motor innervation to the rhomboid major muscle, rhomboid minor muscle, and levator scapulae muscle.
The epineurium is the outermost layer of dense irregular connective tissue surrounding a peripheral nerve. It usually surrounds multiple nerve fascicles as well as blood vessels which supply the nerve. Smaller branches of these blood vessels penetrate into the perineurium. In addition to blood vessels which supply the nerve, lymphocytes and fibroblasts are also present and contribute to the production of collagen fibers that form the backbone of the epineurium. In addition to providing structural support, lymphocytes and fibroblasts also play a vital role in maintenance and repair of the surrounding tissues.
Tarsal tunnel syndrome (TTS) is a nerve compression syndrome or nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is entrapped as it travels through the tarsal tunnel. The tarsal tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.
The intercostal nerves are part of the somatic nervous system, and arise from the anterior rami of the thoracic spinal nerves from T1 to T11. The intercostal nerves are distributed chiefly to the thoracic pleura and abdominal peritoneum, and differ from the anterior rami of the other spinal nerves in that each pursues an independent course without plexus formation.
The thoracodorsal nerve is a nerve present in humans and other animals, also known as the middle subscapular nerve or the long subscapular nerve. It supplies the latissimus dorsi muscle.
Trendelenburg gait, named after Friedrich Trendelenburg, is an abnormal human gait. It is caused by weakness or ineffective action of the gluteus medius muscle and the gluteus minimus muscle.
The short ciliary nerves are nerves of the orbit around the eye. They are branches of the ciliary ganglion. They supply parasympathetic and sympathetic nerve fibers to the ciliary muscle, iris, and cornea. Damage to the short ciliary nerve may result in loss of the pupillary light reflex, or mydriasis.
The flexor retinaculum of foot is a strong fibrous band in the foot.
A cutaneous nerve is a nerve that provides nerve supply to the skin.
The facet joints are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment and each facet joint is innervated by the recurrent meningeal nerves.
The tarsal tunnel is a passage found along the inner leg underneath the medial malleolus of the ankle.
The superior cluneal nerves are pure sensory nerves that innervate the skin of the upper part of the buttocks. They are the terminal ends of the L1-L3 spinal nerve dorsal rami lateral branches. They are one of three different types of cluneal nerves. They travel inferiorly through multiple layers of muscles, then traverse osteofibrous tunnels between the thoracolumbar fascia and iliac crest.
Neural fibrolipoma is an overgrowth of fibro-fatty tissue along a nerve trunk that often leads to nerve compression. These only occur in the extremities, and often affect the median nerve. They are rare, very slow-growing, and their origin is unknown. It is believed that they may begin growth in response to trauma. They are not encapsulated by any sort of covering or sheath around the growth itself, as opposed to other cysts beneath the skin that often are. This means there are loosely defined margins of this lipoma. Despite this, they are known to be benign. Neural fibrolipomas are often more firm and tough to the touch than other lipomas. They are slightly mobile under the skin, and compress with pressure.
Jules Tinel was a French neurologist remembered for describing Tinel's sign.
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.
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.
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.