Jules Tinel

Jules Tinel (1879 – 1952)

Jules Tinel (1879 – 1952) was a French neurologist.

Eponymously affiliated with the Tinel sign (1915). Tinel described the effect when pressure over a damaged nerve generated paraesthesia (tingling sensation). He found that progressing regeneration of the damaged nerve, still without myelin sheath, gave a more peripheral occurrence of the sign. Over subsequent decades the sign was also observed in nerve compression syndromes, such as carpal tunnel syndrome.

Tinel also described paroxysmal hypertension in pheochromocytoma in 1922. Tinel’s later research centred on measurements of intracranial pressure; the autonomic system; the impact of histamines on blood vessels; and the regulation of blood circulation in the brain.


Biography
  • Born 12 October 1879 in Rouen, France
  • 1900-1906 Medical school, University of Rouen in Paris – awarded ‘externe des hôpitaux’. Student of Landouzy and Jules Déjèrine (1849-1917) in neurology and the pathological anatomy of the nervous system
  • 1910 – MD studying the neurological consequences of syphilis These: Les Radiculites et le Tabes, concluding that any form of meningitis (syphilitic or otherwise) involved the nerve roots, particularly the dorsal roots.
  • 1911 – Chef de clinique de Pitié-Salpêtrière Hospital, Paris
  • 1914 – Member of the Société Française de Neurologie
  • 1914-1918 Assistant doctor in the infantry
  • 1915 – Founded a regional neurological center at the front where he studied the consequences of damage to peripheral nerves resulting from ballistic trauma
  • 1922-1936 Research laboratory at La Rochefoucauld studying intracranial pressure the autonomic nervous system; the impact of histamines on blood vessels and regulation of blood circulation in the brain
  • 1936 – President of the Société Française de Neurologie
  • 1940-1945 French resistance movement in the Second World War, organising a network for transportation of wounded pilots to Spain. He was arrested in 1945 but released from prison after a few months.
  • Died of heart failure on 4 March 1952

Medical Eponyms
Tinel sign (Hoffmann-Tinel sign) (1915)

Tinel observed the progress of nerve regeneration after gunshot wounds by pressing proximally over the affected nerves. Tinel described “Le signe du Fourmillement” in numerous injured nerves in 1915.

Original
English

On sait quelle est trop souvent ’la difficulté d’un diagnostic précis dans les lésions des nerfs périphériques 

Y a-t-il section du nerf, compression, déchirure ou irritation? le nerf est-il ou non en voie de régénération? le névrome perçu à la palpation est-il perméable ou non aux cylindraxes? la suture d’un nerf a-t-elle ou non réussi?… Autant de problèmes qui se posent chaque jour pour le clinicien, et dont l’importance est capitale au point de vue du pronostic et du traitement. 

La pression d’un tronc nerveux blessé produit très souvent une impression de fourmillement, extériorisé par le sujet à la périphérie de son nerf, et localisé par lui à un territoire cutané très précis.

Nous pensons que l’étude systématique du fourmillement provoqué par la pression du nerf, peut apporter un concours précieux à la solution de ces problèmes. 

Tinel 1915: 388

It is recognised that it is frequently difficult to make a precise diagnosis in lesions of peripheral nerves.

Is there a division of the nerve, a compression, a tear, or an irritation? Is the nerve in a state of regeneration? Is a palpable neuroma penetrated by axons? Was a nerve suture successful? These are the problems which confront the clinician and are of major importance in diagnosis and treatment.

Pressure applied to an injured nerve trunk frequently produces a sensation of tingling transmitted to the periphery of the nerve and localized to the precise cutaneous region.

We consider that the systemic study of the tingling produced by pressure on a nerve can provide a valuable contribution to the solution of these problems.

Tinel 1915: 388

In his 1916 review of 639 war related peripheral nerve injuries, Tinel added percussion to the technique of the objective examination of the nerve.

Formication provoked by pressure. When compression or percussion is lightly applied to the injured nerve trunk, we often find, in the cutaneous region of the nerve, a creeping sensation usually compared by the patient to that caused by electricity. This formication is quite distinct from the pain on pressure, which exists in nerve irritations.

Tinel 1916: 34 [English translation 1918: 34]

Tinel’s descriptions were detailed and insightful. He described not only the regeneration of sensory nerves, but also accurately predicted that tingling was also a sign that motor nerves would regenerate. He separated pain from tingling, and found that the latter had a high prognostic value, and was a sign that the nerve was regenerating. Tinel discovered that if the tingling no longer progressed, that surgical intervention was required as it was a signal of a mechanical obstacle to nerve regeneration.


Major Publications

References

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eponym

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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