Tinel’s Sign (Wrist)

Tinel’s Sign at the wrist is a physical test used to assess for median nerve irritation or compression in the carpal tunnel, most commonly related to carpal tunnel syndrome (CTS). This test helps screen for nerve damage, entrapment, regrowth, or chronic irritation.

Tinel's Wrist Test

How the Test is Performed

  • Client position: Seated, forearm and hand supported comfortably.

  • The examiner taps lightly and repeatedly (with two fingertips or a reflex hammer) over the volar aspect of the wrist, just proximal to the carpal tunnel (flexor crease).

  • Some protocols recommend tapping along the full distribution of the median nerve (from the wrist toward the palm or index finger).

  • During tapping, the examiner asks the client what they feel.

  • A positive test: Tingling, “pins and needles,” zapping, or shock-like sensation in the thumb, index, middle, and radial half of the ring finger (classic median nerve distribution) is reproduced.

  • Negative test: No symptoms are felt with tapping, though this does not fully exclude CTS.

Clinical Significance

  • Positive Tinel’s Sign indicates median nerve damage, irritation, or regrowth at the wrist, supporting the diagnosis of carpal tunnel syndrome.

  • The test can also track nerve recovery or worsening after injury (the site of tingling indicates the level of regeneration).

  • Sensitivity and specificity are moderate (50–77%)—so it’s best used as part of a diagnostic cluster.

Assessment

  • Use for clients reporting wrist/hand pain, numbness, tingling, or weakness—especially with repetitive use or history of CTS.

  • Document location, quality, and duration of symptoms for targeted treatment and multidisciplinary communication.

Treatment

  • If positive:

    • Avoid deep, repetitive, or compressive manual therapy directly over the carpal tunnel and median nerve.

    • Focus gentle soft tissue techniques for forearm flexors, extensors, and proximal kinetic chain to relieve tension and improve circulation.

    • Educate about activity modification (limit repetitive wrist motion, avoid sustained flexion/extension), ergonomic recommendations, and self-care strategies (rest, splinting, posture corrections).

  • Incorporate nerve glides or gentle neural mobilization techniques as tolerated.

Safety and Referral

  • Refer for further evaluation if symptoms are persistent, severe, or accompanied by functional loss (grip weakness, dropping objects).

  • Collaborate with hand therapists or occupational health as needed for advanced or complex cases.