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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 describing the phenomenon. The Hoffman-Tinel sign is commonly used to indicate 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 canal syndrome.
Issues of Concern
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Issues of Concern
The examiner elicits the Hoffman-Tinel sign by tapping firmly with the fingertip throughout the nerve. Depending on the clinical scenario, the point at which symptoms are provoked indicates nerve compression or regeneration. Recreating 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 less useful in evaluating carpal tunnel syndrome compared to other provocative tests, such as Phalen's or Durkan's tests, which have a greater sensitivity and specificity.[3] The Hoffmann-Tinel's sign remains valid 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 and peripheral nerve regeneration following nerve injury. While the Hoffmann-Tinel sign is valid in 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 confirm and objectively quantify a compression neuropathy or nerve injury diagnosis. 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
Multiple interprofessional healthcare team members can use the Hoffman-Tinel sign to monitor nerve regeneration, compression, or injury.
References
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:35(5):733-734. doi: 10.1007/s00381-018-3895-6. Epub 2018 Jul 9 [PubMed PMID: 29987376]
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:11(2):70-2 [PubMed PMID: 24222987]
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:68(2):141-5 [PubMed PMID: 12050999]
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:142(5):1258-1266. doi: 10.1097/PRS.0000000000004839. Epub [PubMed PMID: 30113445]
Level 2 (mid-level) evidenceGhasemi-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 28:6(6):284-300. doi: 10.4329/wjr.v6.i6.284. Epub [PubMed PMID: 24976931]