Tinel's Sign: Radial Nerve (Proximal Forearm)

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

• Tinel’s sign is a commonly used diagnostic tool for evaluating damage or dysfunction of a specific nerve, and when assessing the radial nerve at the proximal forearm, a positive result is obtained when tapping the nerve elicits tingling or the feeling of “pins and needles,” particularly in the dorsoradial aspect of the hand.

Pathophysiology

• Patients with a proximal radial nerve entrapment like posterior interosseous nerve palsy sometimes have positive Tinel’s sign in the proximal dorsal forearm at the level of the Arcade of Froshse.
• Wartenberg syndrome is a pure sensory nerve entrapment where the sensory cutaneous branch of the radial nerve becomes entrapped as it exits between the brachioradialis and extensor carpi radialis longus tendons in the forearm.²

Instructions

1. Obtain an accurate and complete patient history.
2. Tap over the radial nerve in the proximal forearm.
3. Ask the patient about any abnormal sensations (eg, tingling) in the hand being tested.

Related Signs and Tests²

• Tinel’s sign-ulnar nerve
• Finkelstein's test

Diagnostic Performance Characteristics

• A positive Tinel’s sign over the course of the sensory radial nerve is a common finding, but clinicians should be aware that this may also be positive in patients with more proximal pain generators, such as a lateral antebrachial cutaneous neuritis.³

• A positive result occurs when tapping on the radial nerve causes a tingling or feeling of “pin and needles” in the dorsoradial aspect of the hand.

• A negative result occurs when tapping on the radial nerve does not cause a tingling or feeling of “pin and needles” in the dorsoradial aspect of the hand.

• Tinel’s sign is one of the best known and widely used clinical diagnostic tools in hand surgery, plastic surgery, neurology, and orthopedics.⁶
• Sensory radial nerve compression symptoms may be confused with the symptoms of de Quervain’s tenosynovitis owing to pain with ulnar deviation of the wrist, and in some cases, both conditions may be present simultaneously.³
• Posterior interosseous nerve dysfunction can also be associated with Parsonage-Turner Syndrome rather than a traditional radial nerve entrapment.^7,8

1. Urbano, F. Tinel's sign and Phalen's maneuver: Physical signs of carpal tunnel syndrome. Hosp Phys 2000;36(7):39-44.
2. Hagert, E and Hagert, CG. Upper extremity nerve entrapments: the axillary and radial nerves--clinical diagnosis and surgical treatment. Plast Reconstr Surg 2014;134(1):71-80. PMID: 24622568
3. Dang, AC and Rodner, CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009;34(10):1906-14.PMID: 19969199
4. Dellon, AL and Mackinnon, SE. Radial sensory nerve entrapment in the forearm. J Hand Surg Am 1986;11(2):199-205. PMID: 3958447
5. Rinker, B, Effron, CR and Beasley, RW. Proximal radial compression neuropathy. Ann Plast Surg 2004;52(2):174-80. PMID: 14745268
6. Davis, EN and Chung, KC. The Tinel sign: a historical perspective. Plast Reconstr Surg 2004;114(2):494-9. PMID: 15277821
7. Mamula CJ, Ernhard RE, Piva SR. Cervical radiculopathy or Parsonage-Turner syndrome:     differential diagnosis of a patient with neck and upper extremity symptoms. J Orthop Sports Phys Ther. 2005;35:659–664. [PubMed]
8. Parsonage MJ, Turner JWA. The shoulder girdle syndrome. Lancet. 1948;1:973–978. doi: 10.1016/S0140-6736(48)90611-4. [PubMed]