Tinel's Sign: Ulnar Nerve (Guyon's)

Historical Overview¹

• 1915: Paul Hoffman (1884-1962), a German physiologist, described a sensation of “tingling” or “pins and needles” that could be elicited when an injured nerve was percussed and attributed the sign to nerve regeneration.
• 1915: Jules Tinel (1879-1952), a French neurologist, described a “tingling sensation” or “formication sign” after slight percussion of a nerve trunk after injury to which he attributed the sensation to the presence of growing axons.

Description

• Positive results are obtained when tapping the ulnar nerve at Guyon’s canal elicits the feeling of “pins and needles,” particularly in the ring and little fingers.

Pathophysiology

• May involve abnormal mechanosensitivity of the median nerve resulting in afferent discharge of regenerating nerves.
• On a cellular level, the sign may be caused by a hyper-excitable membrane.

Instructions

1. Tap over the ulnar nerve at Guyon’s canal in the wrist.

Variations

• Published variations in testing for Tinel’s sign at the ulnar wrist are absent. However, it is reasonable to assume that the Tinel test is given as variably as it is on the median nerve and the ulnar nerve at the elbow.

Related Signs and Tests²

• Phalen’s test
• Froment sign
• 2-point discrimination

Diagnostic Performance Characteristics

• The diagnostic performance of Tinel’s sign for detecting ulnar compression at the wrist has not been formally reported.

• A positive test produces paresthesias in the ulnar nerve distribution (ulnar aspect of the ring finger, and little finger).

• A negative test will not produce any parasthesias, numbness or tingling in the hand.

• Positive Tinel's sign at Guyon's canal usually secondary to mass in Guyon's canal like a ganglion or lipoma.
• Location of lesion in the canal will affect either the motor, sensory or both components of the nerve.
• There is no standardized procedure for administering the test
• There has been little formal study of Tinel’s sign at the ulnar wrist.

1. Peimer, C. (1996). Compression Neuropathies: Ulnar. In Surgery of the hand and upper extremity (Vol. 2, pp. 1340, 1345-1346). New York, NY: McGraw-Hill, Health Professions Division.
2. Brown, D. (2004). Orthopedic secrets (Third ed., p. 205). Philadelphia, PA: Hanley and Belfus, an affiliate of Elsevier.
3. Hammert, W. (2010). Nerve. In ASSH manual of hand surgery (1st ed., pp. 318-319). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins
4. Murata K, Shih JT,Tsai TM. Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg Am 2003;28(4):647-51.