Tinel’s test: Technique, positive signs, and accuracy

Tinel’s test is a light tap over a peripheral nerve that tells you whether that nerve is irritated, compressed, or regrowing after injury. A positive result feels like tingling or an electric shock spreading down the nerve’s own territory. Soreness at the spot you tapped does not count, and that single distinction decides most results.

Score it loosely and you refer the wrong patient for nerve conduction studies. Applied carefully, though, the test earns its minute. It localizes the lesion, needs no equipment, and works at three separate sites. Technique first, then how far you can trust what it tells you.

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Key takeaways

Tinel’s test provokes tingling along a nerve by tapping over it, which flags irritation or regrowth.

The wrist covers the median nerve, the elbow the ulnar nerve, and the ankle the tibial nerve.

Only paresthesia that radiates into the nerve’s own territory counts, so local tenderness scores as negative.

Sensitivity at the wrist sits near 50 to 60 percent, so a clean tap never rules out carpal tunnel syndrome.

Specificity at the elbow is far higher, which makes a positive result there much harder to dismiss.

What a positive Tinel’s sign is pointing at

A positive Tinel’s sign tells you where a nerve is unhappy, and sometimes how far it has healed. Tapping over a damaged or compressed nerve fires the sensitized axons at that point. They send a signal down the nerve, and the patient feels it as tingling in the skin that nerve supplies.

That mechanism explains both uses of the sign. In a compression picture, the positive point stays put across repeat visits, so it marks the entrapment. After a repair or a crush injury, the point creeps distally as axons regrow, at roughly a millimeter a day.

Chart where that point sits at each visit and you have a rough recovery curve. A sign that stops advancing is worth flagging, because it often means regrowth has stalled.

Jules Tinel described the finding in 1915 while treating nerve injuries in World War I soldiers. Paul Hoffmann reported it independently, which is why some European texts call it the Hoffmann-Tinel sign.

Three sites cover almost every test you will perform

Nearly every Tinel’s test in practice happens at one of three places. Each has a landmark you can find by palpation, and each screens for a named entrapment.

Knowing where each nerve ends matters as much as knowing where it gets squeezed. The result only counts when tingling reaches the territory that nerve supplies.

How to perform Tinel’s test in six steps

Light percussion over the right landmark, repeated two or three times, is the whole technique. Tap hard and any patient reports discomfort, which is exactly how false positives happen.

The sequence below holds at all three sites:

1. Settle the patient with the limb relaxed and supported. Muscle tension over the nerve blunts the response.
2. Palpate the landmark first. Find it with your fingers before you tap, rather than aiming by eye.
3. Tap two or three times with your index or middle fingertip. Use a reflex hammer at the ankle, where the nerve sits deeper.
4. Ask straight away what the patient felt, and where it traveled. Wait too long and the sensation fades.
5. Separate tenderness from paresthesia. Pain at the tap point, with no radiation, is a negative result.
6. Test the other side whenever you can. A one-sided finding carries far more weight than a matching pair.

The wrist test targets the median nerve

Carpal tunnel syndrome is the most common entrapment you will screen for, so this is the version most clinicians run first. Rest the wrist on a flat surface in neutral or slight extension.

• Landmark: the proximal wrist crease at the palmaris longus tendon, over the flexor retinaculum.
• Technique: tap two or three times with a fingertip. Some examiners then work distally in 1cm steps along the nerve.
• Positive: tingling or electric shock into the thumb, index, middle, and radial half of the ring finger.
• Not positive: local wrist ache, pain only at the tap point, or symptoms on the back of the hand.

At the elbow, the ulnar nerve sits right under your finger

Cubital tunnel syndrome ranks second among upper limb entrapments. The nerve is superficial here, which is why technique matters even more than at the wrist.

• Landmark: the groove behind the medial epicondyle, where you can usually roll the nerve under your fingertip.
• Position: elbow flexed to about 70 degrees, forearm supinated and supported.
• Technique: very light taps over the groove. Firm percussion here provokes almost anyone.
• Positive: tingling into the little finger and the ulnar half of the ring finger. Some patients also report it along the medial forearm.

The ankle test is the one clinicians skip

Tarsal tunnel syndrome is less common than the upper limb entrapments, and it gets missed often because plantar heel pain looks like plantar fasciitis. A quick tap behind the medial malleolus separates the two.

• Landmark: behind and below the medial malleolus, along the posterior tibial nerve.
• Position: supine or seated, ankle in slight eversion to open up the medial side.
• Technique: tap with a reflex hammer or fingertip, working distally toward the sole.
• Positive: tingling into the sole and toes, following the medial and lateral plantar nerves.

How to read a positive, negative, or equivocal result

A positive Tinel’s sign means paresthesia radiated into the nerve’s own dermatome when you tapped. Local pain, diffuse tingling across the whole hand, and a feeling of pressure all score as negative. Two clinical pictures produce a genuine positive: an entrapment irritating the nerve, or axons regrowing after an injury.

A negative result carries less weight than clinicians often assume. Roughly half of patients with confirmed carpal tunnel syndrome tap clean, so a quiet wrist never closes the case.

Read the finding alongside the history, the other provocative tests, and any red flags for motor loss.

Tinel’s test is far more reliable at the elbow than the wrist

Accuracy swings hard by site, and that swing changes what you can do with the answer. At the elbow, a positive sign comes close to confirmatory. At the wrist, treat it as one piece of evidence among several.

The reported figures below make the difference obvious.

The wrist figures repeat consistently across published meta-analyses, so they are safe to quote. Elbow specificity near 98 percent is corroborated in orthopedic series, though percussion technique and study populations vary between them. Read that number as strong rather than settled.

The ankle has no pooled evidence of comparable quality. Use the tap there to support a picture built from history and imaging, and avoid leaning on it by itself.

Why Tinel’s and Phalen’s work better together

Run both and each one covers the other’s weakness. Phalen’s test catches more true cases at the wrist, while Tinel’s raises fewer false alarms. Together they give you a clearer read than either test alone, and they take under two minutes between them.

Clinical guidance from the AAOS points the same way. When both tests turn positive in a patient whose history fits, confidence in a carpal tunnel diagnosis rises well above either result on its own. Our guide to Phalen’s test walks through the technique and how to time it properly.

Which nerve compressions this test helps you catch

Tinel’s test applies wherever a peripheral nerve might be compressed or regrowing. Six presentations account for most of its use in day-to-day practice.

• Carpal tunnel syndrome: median nerve compression at the wrist, and the most common entrapment neuropathy. StatPearls puts the incidence at 1 to 5 percent of the general population.
• Cubital tunnel syndrome: ulnar nerve compression at the medial epicondyle. Patients typically report symptoms that worsen when the elbow stays bent.
• Tarsal tunnel syndrome: posterior tibial nerve entrapment at the ankle, often mistaken for plantar fasciitis.
• Guyon’s canal syndrome: ulnar nerve compression at the wrist rather than the elbow. Tap over the hypothenar eminence instead.
• Thoracic outlet syndrome: a positive sign over the brachial plexus in the supraclavicular fossa supports a neurogenic picture.
• Nerve regeneration: after a repair, laceration, or crush injury, serial testing tracks the advancing front of regrowth.

Upper limb presentations dominate that list. A positive tap at the wrist usually leads straight into a fuller screen, and our rundown of hand nerve tests covers the ones worth adding.

Where the test lets you down

Tinel’s test is a screening tool with well-known failure modes. Five of them explain most bad results, and four sit with the examiner rather than the patient.

• Percussion that is too firm: heavy tapping provokes almost anyone, and anxiety amplifies it. Keep the taps light and controlled.
• Severe, long-standing compression: once enough axons have died, too few remain to fire. Advanced disease can tap clean.
• Inconsistency between examiners: force, landmark, and the question you ask all shift the answer. Agree one method across the team.
• Body habitus and surgical history: edema, higher body mass, and scarring all blunt the stimulus and make landmarks harder to find.
• Loose scoring: diffuse tingling or pain without a distal pattern gets written up as positive far too often.

When a positive Tinel’s sign should trigger a nerve conduction study

Order electrodiagnosis when the result will change what you do next. In practice that means an uncertain diagnosis, a motor sign, conservative care that has stalled, or a surgical referral on the table. Outside those four, the study can wait.

• Nerve conduction studies and EMG: the reference standard for confirming an entrapment. The American Association of Neuromuscular and Electrodiagnostic Medicine supports testing when the clinical picture is unclear or surgery is being considered.
• Ultrasound: high-resolution imaging measures nerve cross-sectional area, which enlarges in compression. It is quick, and it often comes back sooner than electrodiagnosis.
• MRI neurography: reserved for complex cases or a suspected proximal lesion. Rarely a first-line choice.
• Referral thresholds: send on at 6 to 12 weeks if conservative care has failed. Motor weakness, thenar wasting, or confirmed severe compression all warrant an earlier referral.

Before you act on a positive sign, run four quick checks. They take seconds and they catch the errors that send the wrong patient down a referral pathway.

• Did the tingling reach the nerve’s own dermatome, or stop at the tap point?
• Did you palpate the landmark first, then tap lightly two or three times?
• Did you test the other side and compare what the patient reported?
• Does the history match the nerve you provoked, including the pattern of night symptoms?

One tap is a single input. Adding neural tension testing sharpens the picture before you commit to a referral. Our set of upper limb tension tests gives you a sequence to run in the same visit.

How to document Tinel’s test so the next clinician can use it

Write down the site, the method, the patient’s own words, and the radiation pattern. “Tinel’s positive” on its own gives the next clinician no way to act on it, and it reads badly if the notes are ever reviewed. Six items cover a defensible entry.

• Site tested: wrist, elbow, or ankle, with the side stated explicitly.
• Method: fingertip or reflex hammer, number of taps, and how firm they were.
• Patient response: quote them, for example “electric shock into the little finger”.
• Distribution: map the radiation against the expected territory and note whether the two agree.
• Result: positive with the distribution named, negative, or equivocal.
• Comparison: whether you tested the other side, and what it produced.

Two mistakes turn up again and again in reviewed notes. The first is recording a result without the side tested, which makes serial comparison impossible. The second is writing “tingling in the hand” instead of naming the digits, since digit territory is what separates median from ulnar.

Free text invites both errors. A physical therapy EMR can hold each of those six items as its own field. The choice disappears, and the entry comes out the same shape whoever wrote it.

How Pabau keeps special test results consistent across a team

Most practices record special tests in free text, and free text drifts. One clinician writes “Tinel’s +ve R wrist”, another writes a paragraph, and a third leaves it until the end of the day. Six months on, nobody can say whether the sign advanced.

Practice management software like Pabau handles this with structured clinical forms. You build the special test once, with site, technique, patient response, distribution, and result as separate fields. Every clinician then fills in the same form, so the answers land in the patient record instead of someone’s shorthand.

Because capture forms software stores each answer separately, you can pull a patient’s Tinel’s results across four visits and read the pattern at a glance. That matters most in nerve regeneration, where the question is simply whether the positive level has moved.

That audit trail earns its keep later. When a colleague, an insurer, or a review asks what was found in March, the answer takes seconds rather than a scroll through free text.

Capture every special test the same way

Pabau gives physical therapy and sports medicine practices structured clinical forms. Results like Tinel’s land in named fields instead of free text.

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Conclusion

Use Tinel’s test for what it does well. It points at a location, it takes under a minute, and at the elbow it carries genuine diagnostic weight. At the wrist, pair it with Phalen’s and let electrodiagnosis settle the question.

The bigger win is consistency. Score the tap the same way every time, and write it up the same way every visit. A soft sign then becomes a trend you can follow. That is a documentation decision as much as a clinical one.

If you want special test results captured the same way across your whole team, book a demo and see how Pabau structures musculoskeletal notes.

Continue your research

Screening a hand that tests positive? Hand nerve tests sets out the wider screen worth running once a tap comes back positive.

Looking for another carpal tunnel provocation test? The hand elevation test is quick to run and useful when Tinel’s and Phalen’s disagree.

Need a structured neurological exam sheet? Cranial nerve examination checklist gives you a printable format you can adapt for peripheral testing.

Running a multi-practitioner physical therapy practice? Clinic management software for physiotherapy explains how structured tools keep workflows consistent across a team.

Wondering what your records have to show? Physiotherapy clinic compliance requirements outlines the documentation standards regulators expect.

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