A recent email brought the attention to an article examining the intra- and inter-examiner variability of performing the Tinel’s Test. The conclusion basically sums of what any thoughts I have of it…total bull.
Agreeing with conclusions once again, the sensitivity and specificity is so variable that I wouldn’t trust doing it on myself. I have taken it out of my routine as the 10 seconds it takes is a waste of time.
Honestly, I think the test is overrated. No offense to Jules Tinel but it seems like if we tap on anything in the body and distal neurological symptoms occur, we consider it positive and jump to conclusions as if we found the diagnosis!
For example, we usually perform the Tinel’s (percussion) test on the wrist to reproduce paresthesias along median nerve distribution for CTS. However, according to Cook & Hegedus, 29 studies have been performed showing variations in number of taps, pressure of taps, tapping object (hammer, finger), position of wrist (extension, neutral, etc) and comparison to criterion standard. The sensitivity, specificity, LR+, LR- & diagnostic values were all over the board. Frankly, it does nothing in the clinic and of no diagnostic value. This was even found in 1979, 30 years later…why do we still do it!?
What are your thoughts on the Tinel’s Test/Sign? Do you find it to be diagnostic?
Cook C, Hegedus E. Orthopedic Physical Examination Tests: An Evidence-Based Approach. Prentice Hall. 2007.