Phalen sign

Description

The Phalen test is performed by asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists at 90 degrees for 60 seconds. A positive test is defined as the occurrence of pain or paresthesias in at least one finger innervated by the median nerve.

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

Associated Persons

• George S. Phalen (1911 – 1998)

Alternative names

• Phalen’s sign
• Phalen’s test, Phalen’s maneuver
• Wrist-flexion test

References

• 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.
• Joseph Z. Clinical Signs in Carpal Tunnel Syndrome. 2020