Tinel's sign

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Tinel's sign

a tingling sensation in the distal end of a limb when percussion is made over the site of a divided nerve; it indicates a partial lesion or the beginning regeneration of the nerve.

Tinel's sign

Etymology: Jules Tinel, French neurosurgeon, 1879-1952
an indication of irritability of a nerve; a distal tingling sensation on percussion of a damaged nerve. The sign is often present in carpal tunnel syndrome and is produced by tapping over the median nerve on the volar aspect of the wrist.


objective features of disease, and noted by examining clinician (contrast with symptoms); note: eponymous signs are denoted as 'positive' when their characteristics are present
  • Babinski's sign characteristics of an upper motor neurone lesion (UMNL; e.g. cerebrovascular accident; cerebral palsy), i.e. hip, knee, elbow and wrist flexion, ankle plantar flexions, forearm pronation, and an extensor plantar response on contralateral side to UMNL (see response, extensor plantar)

  • Chaddock's sign stimulation of lateral malleolar skin causes hallux extension at first metatarsophalangeal joint; diagnostic of corticospinal (motor tract) reflex path pathology

  • Chvostek's sign hemifacial tic, induced by tapping the facial nerve just below cheek bone; indicative of hypercalcaemia

  • clenched-fist sign pressing the clenched fist against anterior central chest wall; characteristic of angina pectoris

  • daylight sign see sign, Sullivan's

  • Erb-Westphal sign loss of knee jerk reflex; characteristic of spinal cord motor tract pathology

  • Gower's sign attaining upright posture from sitting by pushing with the hands against anterior thighs ('climbing up the legs'); characteristic of Duchenne muscular dystrophy

  • Homan's sign calf pain on ankle dorsiflexion; characteristic of calf deep-vein thrombosis

  • Hutchinson's sign pigment 'overspill'/ 'washout' into surrounding tissues from a melanoma; denotes local spread of lesion

  • Leser-Trelat sign rapid development of multiple seborrhoeic keratotic skin lesions; associated with underlying malignancy

  • Lhermitte's sign sudden 'electrical' pains that extend down the spine when head is flexed on neck; characteristic of multiple sclerosis and cervical cord compression

  • oil drop sign small area of yellowish onycholysis, caused by elevation of nail plate from bed; characteristic of psoriasis

  • Remak's sign pain in response to innocuous stimuli; characteristic of polyneuritis and painful neuropathies, e.g. diabetic neuropathy and complex regional pain syndromes

  • Romberg's sign loss of/poor balance when standing with eyes closed; characteristic of proprioception loss or cerebellar dysfunction

  • Sever's sign exacerbation of heel pain when standing on tiptoe on affected side; characteristic of calcaneal apophysitis (Sever's disease)

  • Stewart-Holmes sign; rebound phenomenon inability to control limb movement when passive limb resistance is suddenly released; characteristic of cerebellar dysfunction

  • suction sign increased ankle joint movement, with formation of a depression between lateral malleolus and talus (demonstrated by positive anterior drawer test); diagnostic of anterior talofibular ligament dysfunction

  • Sullivan's sign; sunray sign; daylight sign separation/divergence of two adjacent toes; characteristic of forefoot rheumatoid disease (i.e. metatarsophalangeal joint synovitis, intermetatarsal oedema, bursitis) or plantar digital neuroma

  • sunray sign see sign, Sullivan's

  • Tinel's sign dermatomal tingling/paraesthesia on percussion of subserving nerve trunk; characteristic of nerve trunk compression, nerve injury or early nerve repair subsequent to nerve lesion; e.g. paraesthesia in sole of a foot with tarsal tunnel syndrome, when tibial nerve is percussed posterior to medial malleolus; or in palm of a hand with carpal tunnel syndrome, when radial nerve is percussed at volar aspect of wrist

  • 'too many toes' sign visualization of fifth, fourth, third, second and even first toes when patient is viewed from behind when standing in relaxed calcaneal stance; characteristic of excess foot pronation/forefoot abduction

  • Trendelenburg's sign anterior tilt of upper pelvis on flexion of hip and knee of non-weight-bearing limb (i.e. during swing phase of gait) whilst weight-bearing on other leg (e.g. observed as patient climbs stairs); characteristic of congenital hip joint dislocation or hip adductor weakness (normally non-weight-bearing pelvis tilts upward during swing phase of gait)

  • Trousseau's sign sharp flexion movements of the wrist and metacarpophalangeal joints and extension of the fingers when a blood pressure cuff, inflated to above systolic pressure, is left in situ for 3 mins; characteristic of latent tetany and indicative of hypocalcaemia

  • Valleix' sign proximal tingling and plantar paraesthesia when tibial nerve is percussed posterior to medial malleolus (see sign, Tinel's)

  • vital signs signs of life (breathing, heart beat and sustained blood pressure)

  • Ward's sign distended/engorged superficial dorsal foot and lower-leg veins due to venous hypertension and secondary to arteriovenous shunting; characteristic of diabetic autonomic neuropathy

References in periodicals archive ?
As noted above though specificity of Tinel's sign is high, the sensitivity is not; hence, the author has attempted to increase the sensitivity also by adding tourniquet test and Tinel's with tourniquet test to the former to make a series of three tests in continuum.
These tumors are transversely mobile and longitudinally immobile, have a positive Tinel's sign, and exertional dysathesias or pain.
Percussion of the posterior tibial nerve (Tinel's sign) may cause parethesias along the course of the nerve, (3,8,9) with one study reporting that Tinel's sign is positive in only 67% of cases.
Sensitivity of the scratch-collapse test in subjects with carpal tunnel syndrome was 75%, compared with 37% for Tinel's sign and 47% for Phalen's test.
Using various methods for assessment, including two-point discrimination tests, monofilaments, vibratory stimuli, Tinel's sign, ninhydrin, and electrodiagnostic tests, nerve recovery occurs in a predictable, orderly fashion.
In the posttraining screening examination, the following subjects had findings on the physical examination to suggest median or ulnar abnormalities: subject 7 had a positive Tinel's sign over the median nerve at the wrist in both hands (median, pretraining finding); subject 8 had a positive Tinel's sign over the left ulnar nerve at the elbow and wrist (ulnar, pretraining finding) and decreased sensation to light touch and pain in the palmar surface of left D5 (ulnar, new); subject 11 had a positive Tinel's sign over the right median nerve at the wrist (median, new); and subject 12 had decreased sensation to the palmar aspect of the left D5 (ulnar, new).
1,13) Tinel's sign (pain created by percussion over the area of the femoral nerve) will be positive over the inguinal ligament.
Neurosensory testing with a pressure-specified sensory device had been used to document sensory abnormalities in these patients, and examination revealed a positive Tinel's sign over the involved nerve, indicating nerve irritation.