George Phalen

George S. Phalen (1911 – 1998)

George S. Phalen (1911 – 1998) was an American Orthopedic Surgeon.

Phalen defined our understanding of carpal tunnel syndrome aetiology, assessment and management between 1950 and 1980. His work on carpel tunnel syndrome spanned decades and was instrumental in leading recognition and treatment of this ever recognisable disease. Prior to his work, physicians had fragmented the disease based on the presence or absence of trauma, whereas Phalen demonstrated they were a spectrum of the same disease.

He is most commonly known for ‘Phalen’s test’, a clinical test used to aid the diagnosis of carpal tunnel syndrome


Biography

  • Born 2nd 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 14th 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.

Phalen test wrist-flexion test in carpal tunnel 1950 fig 2
Fig 2. The wrist-flexion test is positive when numbness and paresthesia in the median-nerve distribution in the hand are reproduced or exaggerated by holding the wrists in complete flexion for from thirty to sixty seconds. Phalen 1950

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


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


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eponym

the person behind the name

MB BCh. UK Doctor working in Emergency medicine in Perth, Australia.

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