George Phalen

Biography

• Born 2^nd December 1911, Peoria, Illinois
• 1932 Graduated in undergraduate studies from Bradley University, Peoria, Illinois
• 1937 Graduated with Masters degree in Anatomy and Medical Degree from Northwestern University, Illinois
• 1937 – 1940 Residency at the Mayo Clinic, Rochester, Minnesota
• 1942 On joining the army, he rose to the positions of Lieutenant colonel and Chief of the Orthopaedic Section, O’Reilly General hospital, Springfield, Missouri. Later he became Chief of the Hand Service at William Beaumont General hospital, El Paso, Texas.
• 1945 – Following the conclusion of the Second World War, Phalen established practice of hand surgery at the Cleveland Clinic and lectured at the Western Reserve School of Medicine
• 1946 Assisted in organizing the first meeting of the “American Society for Surgery for the Hand”. He would later go on to become its president.
• 1948 Presented his diagnostic test for Carpal tunnel to the American Surgery for the Hand annual conference. The test later became synonymous with the name “Phalen’s sign”
• 1965 President of the Association of Bone and Joint Surgeons
• 1966 Published his now rewound case series on Carpal Tunnel. His works involved the study of 439 patients with median nerve compression
• 1969 Chair of the Orthopaedic Section of the American Medical Association
• 1970 Presented with the Distinguished Alumnus Award by Bradley University
• 1970 – 1980 Moved to Texas to practice at the Dallas Medical and Surgery Clinic
• 1980 Retired from medical practice
• Died 14^th April 1998

Medical Eponyms

Phalen’s test [Phalen’s maneuver] (1951)

A provocation test used to aid the diagnosis of carpal tunnel syndrome. The patient is asked to flex at the wrist and hold the position for up to a minute. A positive test elicits pain, paraesthesia, or numbness over median nerve distribution in the affected hand.

In performing the so called wrist-flexion test, the patient is asked to hold their forearms vertically and allow both hands to drop into complete flexion at the wrist for approximately one minute. In this position the median nerve is squeezed between the proximal edge of the transverse carpal ligament and the adjacent flexor tendons ad radius. Maintaining this position for a long time eventually causes numbness and tingling over the distribution of the median nerve

Phalen 1950: 214

Major Publications

• Phalen GS, Gardner WJ, Londe AA. Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg Am. 1950; 32A(1): 109-12.
• Phalen GS. Spontaneous compression of the median nerve at the wrist. JAMA 1951;145:1128-1133.
• Phalen GS. The carpal tunnel syndrome. Instr Course Lect. 1957; 14: 142-8.
• Phalen GS. The carpal-tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48(2):211-228.
• Phalen GS. The diagnosis of carpal tunnel syndrome. Cleve Clin Q. 1968; 35(1): 1-6.
• Phalen GS. Reflections on 21 years’ experience with the carpal-tunnel syndrome. JAMA. 1970; 212(8): 1365-7.
• Phalen GS. The carpal-tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop Relat Res. 1972; 83: 29-40
• Phalen GS. The birth of a syndrome, or carpal tunnel revisited. J Hand Surg Am. 1981; 6(2): 109-10.

Controversies

• Carpal tunnel syndrome had previously been described by physicians including James Paget [1854:42-44] and James Jackson Putman [1880;4:147-162]
• Phalen was not the first to suggest that compression of the median nerve at the carpal tunnel was the mechanism responsible. Marie and Fiox first proposed this in 1913 following their studies of cadaver specimens. It was however Phalen than popularised this theory with his publications.

References

• Amadio PC. The Mayo Clinic and Carpal Tunnel Syndrome. Mayo Clin Proc 1992; 67: 42-48
• Pearce JMS. James Paget’s median nerve compression (Putnam’s acroparaesthesia). Pract Neurol. 2009; 9(2): 96-9.
• Boskovski MT, Thomson JG. Acroparesthesia and carpal tunnel syndrome: a historical perspective. J Hand Surg Am. 2014 Sep;39(9):1813-1821.e1
• Boskovski MT, Thomson JG. Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: a historical perspective. J Hand Surg Am. 2014 Sep;39(9):1822-1829.e1
• Phalen, George S – Encyclopedia of Cleveland History; Cape Western University
• Joseph Z. Clinical Signs in Carpal Tunnel Syndrome. 2020