What does the Prayers sign test involve and what indicates a positive result?

• A. Maximally extend wrists so both palms are in full contact; hold for one minute; positive numbness or tingling
• B. Flex wrists maximally; palms together; hold for 30 seconds; positive pain
• C. Extend wrists to the sides; hold for two minutes; positive numbness
• D. Clasp hands with fingers interlaced and extend wrists; hold for 90 seconds; positive numbness

Answer: (A)

The main idea is to provoke median nerve symptoms by placing the wrists in a position that maximally compresses the carpal tunnel. In this test, you have the patient extend both wrists fully and press the palms together in a prayer-like posture, then hold that position for about a minute. If numbness or tingling appears in the median nerve distribution (thumb, index, middle finger, and part of the ring finger), it suggests median nerve irritation or compression consistent with carpal tunnel syndrome. This is why the described approach—maximal wrist extension with the palms in full contact and a positive tingling sensation—is the best fit. The other positions involve different wrist postures (flexion or alternative alignments) and yield different sensory responses, so they don’t match the prayer sign test as described.