What is the Phalen's test protocol?

What is the Phalen's test protocol?

• A. Wrists are held in full flexion with dorsal surfaces pressed together for up to 60 seconds
• B. Wrists flexed 90 degrees with palms facing each other for 30 seconds
• C. Wrists extended fully with dorsal surfaces pressed together for 60 seconds
• D. Wrists in neutral with fingers extended for 2 minutes

Answer: (A)

The test is designed to provoke symptoms of median nerve compression at the carpal tunnel by maximally flexing the wrists. In Phalen’s test, you hold both wrists in full flexion with the dorsal surfaces pressed together for up to about 60 seconds. This position narrows the carpal tunnel and increases pressure on the median nerve, so if carpal tunnel syndrome is present, numbness, tingling, or paresthesias in the median-nerve distribution (thumb, index, middle finger, and the radial side of the ring finger) often appear within that time frame. A positive result is the reproduction of these symptoms. The other described positions don’t place the median nerve under the same provocative pressure: extending the wrists with the palms together (the reverse position) or holding them in neutral with fingers extended do not produce the same median-nerve provocation, which is why they aren’t the correct protocol for this test.

The test is designed to provoke symptoms of median nerve compression at the carpal tunnel by maximally flexing the wrists. In Phalen’s test, you hold both wrists in full flexion with the dorsal surfaces pressed together for up to about 60 seconds. This position narrows the carpal tunnel and increases pressure on the median nerve, so if carpal tunnel syndrome is present, numbness, tingling, or paresthesias in the median-nerve distribution (thumb, index, middle finger, and the radial side of the ring finger) often appear within that time frame. A positive result is the reproduction of these symptoms.

The other described positions don’t place the median nerve under the same provocative pressure: extending the wrists with the palms together (the reverse position) or holding them in neutral with fingers extended do not produce the same median-nerve provocation, which is why they aren’t the correct protocol for this test.