Tinel’s Sign (Elbow)

Tinel’s Sign at the elbow is a clinical test used to assess for ulnar nerve entrapment (cubital tunnel syndrome) at the medial aspect of the elbow. The test aims to elicit symptoms of nerve irritation, typically tingling or “pins and needles” in the distribution of the ulnar nerve.

Tinel's Sign Elbow Test

How the Test is Performed

  • Client position: Seated, elbow flexed and relaxed or extended at the table.

  • The therapist supports the arm and taps gently with the fingertip, reflex hammer, or end of a blunt object just proximal to the cubital tunnel (medial elbow groove).

  • Tapping is performed several times (usually 4-6 taps), and the client is asked to report any sensations.

  • A positive Tinel’s Sign: The client reports tingling, numbness, or pain radiating into the medial forearm and the ring and little fingers (“ulnar distribution”).

Clinical Significance

  • Positive Tinel’s Sign indicates ulnar nerve irritation or inflammation at the elbow, consistent with cubital tunnel syndrome.

  • Used to help diagnose peripheral neuropathy, nerve trauma, or chronic nerve compression at the elbow.

  • Sensitivity and specificity of the test are moderate; use in conjunction with other findings (history, grip strength, nerve conduction studies) for accurate diagnosis.

Assessment

  • Employ Tinel’s Sign in clients complaining of medial elbow pain, tingling/numbness in the ring/pinky fingers, grip weakness, or suspected nerve entrapment.

  • Document the location and quality of symptoms and correlate with other physical and functional findings for comprehensive assessment.

Treatment

  • If positive:

    • Avoid deep, aggressive, or repetitive massage over the cubital tunnel and medial elbow (“endangerment site”) to minimize risk of worsening nerve injury.

    • Focus gentle manual therapy upstream (shoulder girdle, upper trapezius, forearm muscles) for compensatory tension, using caution around the nerve itself.

    • Educate clients to avoid prolonged elbow flexion, direct pressure, or repetitive movement that can aggravate nerve irritation.

Safety and Referral

  • Refer for medical/physiotherapy assessment if symptoms are persistent, severe, functionally limiting, or worsening, especially if muscle wasting or chronic numbness is present.

  • Document results and explain their importance to the client for ongoing management.