In case of carpal tunnel syndrome, the examiner percusses with two fingers or a reflex hammer over distal palmar crease in the midline over the median nerve.
In case of tarsal tunnel syndrome, the patient is prone with the knee flexed 90°. The examiner taps the tibial nerve posterior to the medial malleolus with with two fingers or a reflex hammer.
In case of other nerve pathology, the the examiner percusses with two fingers over the affected area of the nerve.
What does a positive Tinel Test mean?
Positive if patient reports paresthesia along the distribution of the tested nerve.
Sensitivity & Specificity
Sensitivity: 70 %
Specificity: 90 %
Variations exist between studies on the location and number of taps necessary to elicit a positive response, and in some studies the test is performed by tapping the median nerve in 20 degrees of wrist extension, while others tap along the path of the median nerve up to where the median nerve enters the carpal tunnel.
Tinel, J. (1978) The “tingling sign” in peripheral nerve lesions (Translated by EB Kaplan). In: M. Spinner M (Ed.), Injuries to the Ma jor Branches of Peripheral Nerves of the Forearm. (2nd ed.) (pp 8–13). Philadelphia: WD Saunders Co
Chin-Wei Liu, Tien-Wen Chen, Ming-Cheng Wang, Chia-Hsin Chen, Chia-Ling Lee, Mao-Hsiung Huang: Relationship between carpal tunnel syndrome and wrist angle in computer workers. Kaohsiung J Med Sci. 2003 Dec;19(12):617-23. doi: 10.1016/S1607-551X(09)70515-7. PMID: 14719559
Clinical Tests for the Musculoskeletal 3rd Ed. Book