In Tinels sign, where is tapping performed and what indicates a positive result?

• A. Upper extremity is supported in supination; Tap the volar surface of the wrist. Positive is tingling
• B. Upper extremity is supported in pronation; Tap the volar surface of the wrist. Positive is numbness
• C. Upper extremity is supported in neutral; Tap the dorsal surface of the wrist. Positive is tingling
• D. Arm is raised with the elbow extended; Tap the volar surface of the wrist. Positive is numbness

Answer: (A)

Tinel's sign checks irritation or compression of the median nerve at the carpal tunnel by tapping the wrist. The tap is done on the volar (palmar) surface where the median nerve passes through the carpal tunnel, and a positive result is the patient feeling tingling or an electric shock sensation in the median nerve distribution (thumb, index, and middle fingers). The upper extremity is simply supported in a relaxed position; the exact forearm position can vary, but tapping the volar wrist with a positive tingling response best matches this test. Tapping the dorsal surface or reporting numbness without the characteristic paresthesia is less consistent with a positive Tinel’s sign.