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Phalen's Test | Carpal Tunnel Syndrome (CTS)

Dr Rohit Bhaskar
Dr Rohit Bhaskar
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It is a provocative test used in the diagnosis of CTS. This occurs when the median nerve is compressed or squeezed at the wrist. The pain is often worst at night. Daily activities such as driving and typing may increase the symptoms. The most common complaints are;

  • pain and tingling of hands and fingers
  • numbness in the fingers (specifically the thumb, forefinger and a part of the middle finger)
  • pain in or near the wrist.
  • pain extending into the arm (less frequent)
  • skin lesions in the territory of the median nerve are possible due to compression of blood vessels in the carpal tunnel

Phalen's Test


To test for carpal tunnel syndrome (CTS)


The patient places her flexed elbows on a table, allowing her wrists to fall into maximum flexion. The patient is asked to push the dorsal surface of her hands together and hold this position for 30-60 seconds. This position will increase the pressure in the carpal tunnel, in effect compressing the median nerve between the transverse carpal ligament and the anterior border of the distal end of the radius.

Another way to describe the standard Phalen's test: the patient leaves his / her elbows bent between 0 ° -30 °. Then the therapist asks the patient to supinate his / her forearm. After this the therapist carries a maximum palmar flexion of the wrist and holds it for 60 seconds. During the test the patient will be asked to explain each 15 seconds what she feels.

Reverse Phalen's test : The patient maintains a position of full wrist and finger extension for two minutes. The pressure on the carpal tunnel increases after 10 seconds (compared to 20-30 seconds for the standard Phalen test). The longer the position is held, the greater the pressure on the wrist and carpal tunnel.

Positive test : Both Phalen test and Reverse Phalen's tests are considered positive when the patient's symptoms are reproduced, test gives the same symptoms as that experienced with carpal tunnel syndrome, namely paresthesia (buring, tingling, numbness) in the distribution of the median nerve.

Negative test : Patient feels no pain or any other symptom, even if the motion is maintained for three minutes or longer.

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