Which trio of tests is listed for carpal tunnel evaluation?

• A. Tinels sign, Phalens test, Prayers sign
• B. Tinels sign, Phalen's test, Prayers sign
• C. Tinels sign, Phalens test, Prayer sign
• D. Tinels sign, Phalen's test, Prayer's sign

Answer: (A)

Evaluating carpal tunnel syndrome relies on provocative maneuvers that load the median nerve at the wrist. Tinel’s sign is tested by tapping over the carpal tunnel; if tingling or paresthesias occur in the median nerve distribution, the test is considered positive. Phalen’s test involves holding the wrists in full flexion (or pressing the dorsal hands together) for about a minute; the return of numbness or tingling in the median distribution supports median nerve compression. The prayer sign—placing the hands palm-to-palm with wrists flexed—further stresses the tunnel, and reproduction of symptoms here also indicates median nerve involvement.

Together, these three maneuvers form the classic battery used to evaluate carpal tunnel syndrome, so the trio listed—Tinel’s sign, Phalen’s test, and the prayer sign—best fits the evaluation. Variations in the spelling of the third test exist, but the concept remains the same.