Phalen's maneuver

Phalen's Maneuver is a diagnostic test for carpal tunnel syndrome discovered by an American orthopedist named George S. Phalen. The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. This maneuver moderately increases the pressure in the carpal tunnel and has the effect of pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and confirms carpal tunnel syndrome.

Accuracy

In studies of diagnostic accuracy, the sensitivity of the Phalen's maneuver ranged from 51% to 91% and its specificity from 33% to 88%.

Reverse Phalen's Test

This test is performed by having the patient maintain full wrist and finger extension for two minutes. The reverse Phalen's test significantly increases pressure in the carpal tunnel within 10 seconds of the change in wrist posture and the carpal tunnel pressure has the tendency to increase throughout the test's duration. In contrast, the change in carpal tunnel pressure noted in the standard Phalen's test is modest and plateaus after 20 to 30 seconds.

The average pressure change for Phalen's test at one and two minutes was only 4 mm Hg. The average pressure changes in the carpal tunnel for the reverse Phalen's test were 34 mm Hg at one minute into the test and 42 mm Hg at the two minute point.

The extended wrist posture significantly changes the pressure within the carpal tunnel and may be more useful as a provocative examination maneuver. Reverse Phalen's Maneuver results in a significantly higher intracarpal canal hydrostatic pressure as compared to a traditional Phalen's. [cite journal |author=Werner R, Bir C, Armstrong T |title=Reverse Phalen's maneuver as an aid in diagnosing carpal tunnel syndrome |journal=Archives of physical medicine and rehabilitation |volume=75 |issue=7 |pages=783–6 |year=1994 |pmid=8024425 |doi=10.1016/0003-9993(94)90010-8] This is thought to add to the sensitivity of conventional screening methods.

Comparison

Phalen's maneuver is more sensitive than Tinel's sign. [Cherian A, Kuruvilla A. 2006. [http://www.annalsofian.org/article.asp?issn=0972-2327;year=2006;volume=9;issue=3;spage=177;epage=182;aulast=Cherian "Electrodiagnostic approach to carpal tunnel syndrome."] Ann Indian Acad Neurol 9:177-182.]

References

* D'Arcy CA, McGee S. 2000. “The rational clinical examination. Does this patient have carpal tunnel syndrome?” JAMA 283(23): 3110-3117.

* McKechnie, B. 1995. “Carpal Tunnel Syndrome: Provocative Maneuvers,” Dynamic Chiropractic 13(8).