Hoffmann Tinel Sign

Article Author:
Tung Ho
Article Editor:
Matthew Braza
Updated:
3/15/2020 2:29:56 PM
PubMed Link:
Hoffmann Tinel Sign

Definition/Introduction

The Hoffman-Tinel sign, now more commonly known as the Tinel sign, was defined in 1915 by Paul Hoffmann and Jules Tinel as the "pins and needle feeling" elicited by tapping on a nerve proximally, with resulting paresthesia experienced in the corresponding distal cutaneous distribution of an injured peripheral nerve. Hoffmann and Tinel both, individually, provided reports at the same time describing the phenomenon. The Hoffman-Tinel sign is now used commonly as an indication of peripheral nerve fiber compression or regeneration.[1] Although it is most associated with carpal tunnel syndrome, the Hoffman-Tinel sign is generalized, and an examiner can also elicit it in other known neuropathies such as tarsal tunnel syndrome, cubital tunnel syndrome, or Guyon's canal syndrome.

Issues of Concern

The examiner elicits the Hoffman-Tinel sign by tapping firmly with the fingertip over the course of the nerve. The point at which symptoms are provoked indicates nerve compression or regeneration depending on the clinical scenario. Recreation of the "pins and needles" feeling is considered a positive Hoffman-Tinel sign. Literature has shown a diverse variety in the sensitivity of the Hoffman-Tinel sign (23 to 67%), though it has been generally observed to be highly specific (95 to 99%).[2] The absence of the Hoffmann-Tinel sign does not necessarily rule out the diagnosis. Due to the entrapped nerve compression, the progressive axonal loss may not be appropriately diagnosed, yielding a false negative.  Studies have also shown that Tinel's Sign is not as useful in the evaluation of carpal tunnel syndrome compared to other provocative tests such as Phalen's test or Durkan's test, which have a greater sensitivity and specificity.[3] The Hoffmann-Tinel's sign remains a valid measure when diagnosing tibial nerve abnormality at the tarsal tunnel.[4]

Clinical Significance

The Hoffman-Tinel sign is one provocative test that can help clinicians diagnose entrapment neuropathies as well as peripheral nerve regeneration following nerve injury. While the Hoffmann-Tinel sign is a valid measure in clinically diagnosing nerve entrapment, it should not supplant a thorough patient history and further clinical evaluation. Electrodiagnostic testing, such as electromyography and nerve conduction studies, can be used to confirm objectively quantify the diagnosis of a compression neuropathy or nerve injury.  If the clinical exam and electrodiagnostic testing are not definitive, magnetic resonance imaging can be an option to visualize nerve pathology in detail.  Given the cost, time, and quality of other diagnostic tests, MRI use is rare for this purpose.[5]  

Nursing, Allied Health, and Interprofessional Team Interventions

The Hoffman-Tinel sign can be used by multiple members of the care team to monitor nerve regeneration, compression, or injury. Evidence for the use of the Hoffman-Tinel sign is Level 4 and 5. 


References

[1] Turgut AÇ,Tubbs RS,Turgut M, Paul Hoffmann (1884-1962 AD) and Jules Tinel (1879-1952 AD), and their legacy to neuroscience: the Hoffmann-Tinel sign. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2019 May;     [PubMed PMID: 29987376]
[2] Wiesman IM,Novak CB,Mackinnon SE,Winograd JM, Sensitivity and specificity of clinical testing for carpal tunnel syndrome. The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique. 2003 Summer;     [PubMed PMID: 24222987]
[3] Brüske J,Bednarski M,Grzelec H,Zyluk A, The usefulness of the Phalen test and the Hoffmann-Tinel sign in the diagnosis of carpal tunnel syndrome. Acta orthopaedica Belgica. 2002 Apr;     [PubMed PMID: 12050999]
[4] Rinkel WD,Castro Cabezas M,van Neck JW,Birnie E,Hovius SER,Coert JH, Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Nondiabetic Subjects: A Cross-Sectional Study. Plastic and reconstructive surgery. 2018 Nov;     [PubMed PMID: 30113445]
[5] Ghasemi-Rad M,Nosair E,Vegh A,Mohammadi A,Akkad A,Lesha E,Mohammadi MH,Sayed D,Davarian A,Maleki-Miyandoab T,Hasan A, A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World journal of radiology. 2014 Jun 28;     [PubMed PMID: 24976931]