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A Standardized Method for Measurement of Elbow Kinesthesia

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Intra- and inter-examiner variability in performing Tinel's test.

Scott D Lifchez¹, Kenneth R Means, Reginald E Dunn

¹Johns Hopkins University, Department of Surgery, Division of Plastic Surgery, Baltimore, MD, USA. slifche1@jhmi.edu

The Journal of Hand Surgery

|February 10, 2010

Summary

The Tinel sign, used for nerve compression, lacks standardization. This study found significant force variability among examiners using different techniques, potentially explaining inconsistent clinical results.

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Area of Science:

Neurology
Orthopedic Surgery
Clinical Diagnostics

Background:

The Tinel sign has been used since the 1950s to identify nerve compression sites.
Standardization of Tinel sign elicitation techniques is lacking.
Variability in elicitation may impact diagnostic accuracy.

Purpose of the Study:

To evaluate intra- and inter-examiner variability in the force applied during different Tinel sign techniques.
To assess differences in force generation across three distinct Tinel-type maneuvers.

Main Methods:

Nine clinicians with varying experience levels participated.
Three techniques were tested: single-finger strike, double-finger strike, and preload.
Each clinician performed multiple strikes per technique using a load cell.

Main Results:

Significant differences in force were observed between the preload technique and the finger strike techniques.
Differences in force were also noted between single- and double-finger strikes.
Substantial variability in force was found among different examiners for each technique.

Conclusions:

Current methods for eliciting the Tinel sign lack standardization.
Considerable intra- and inter-examiner force variability exists.
This variability may contribute to inconsistent Tinel sign sensitivity and specificity in clinical practice.