Phalen’s Test

What is the Phalen’s test?

Phalen’s test is a series of hand and wrist movements and positions healthcare providers use to diagnose carpal tunnel syndrome. You might see it referred to as Phalen’s sign or the Phalen’s maneuver. Providers use these names interchangeably.

It’s an in-office physical exam, which means a provider can perform it without any special equipment or a separate appointment. Your provider will ask you to hold your hands and wrists in different positions that put light pressure on the median nerve in your wrist. If any of these movements make you feel tingling or numbness, it’s usually a good indicator that you have carpal tunnel syndrome.

You might need an imaging test to confirm that you have carpal tunnel syndrome or to identify irritation inside your wrist.

When would I need the Phalen’s test?

You might need the Phalen’s test if a provider thinks you have carpal tunnel syndrome. If you visit a provider with wrist pain or other symptoms in your hands and fingers, they might have you perform a Phalen’s test as part of your physical exam.

Carpal tunnel syndrome is one of the most common conditions that affect people’s hands and wrists. The carpal tunnel is formed by the bones in your wrist that lets tendons, ligaments and nerves pass through it to reach the rest of your hand. Carpal tunnel syndrome happens when something irritates or puts extra pressure on the median nerve that runs through your carpal tunnel.

Who performs the Phalen’s test?

You’ll perform the motions and hand positions that makeup Phalen’s test. You won’t use any special equipment or need to prepare. Your provider will show you how to position your arms, hands and wrists correctly. They’ll supervise you while you hold your hands in those positions.

How is the Phalen’s test performed?

The different positions of the Phalen’s test put light pressure on your carpal tunnel. Tell your provider if any part of the Phalen’s test is painful or makes you uncomfortable.

The test is simple and includes the following hand and wrist positions:

• With your hands at around waist height, you’ll place the back of your hands (the dorsal side) together.
• Holding your hands in that position, you’ll raise your arms so your elbows are at about your chest level.
• Your provider will ask you to hold that position for around a minute.
• They’ll ask if you feel any tingling in your fingers or along the sides of your hand.

What is a reverse Phalen’s test?

The reverse Phalen’s test is very similar to the Phalen’s test. It’s a different set of motions and hand positions that also check for symptoms of carpal tunnel syndrome. Your provider might have you perform one or both tests during your exam.

The steps to perform a reverse Phalen’s test include:

• With your hands at around chest height, you’ll place your palms together with your elbows pointed out (away from the center of your body). Picture the position some people hold their hands in while they’re praying.
• Keeping your elbows in place, you’ll lower your hands toward your stomach.
• Your provider will ask you to hold your hands near your belly button for around a minute.

How do I prepare for the Phalen’s test?

You don’t have to do anything to prepare for a Phalen’s test. Visit a provider if you notice new symptoms in your wrist, hands or fingers.

What should I expect during the Phalen’s test?

Try to perform the motions and hold the positions as long as your provider asks. You might feel some discomfort or tingling if you have carpal tunnel syndrome, but you shouldn’t feel intense pain.

What should I expect after the Phalen’s test?

After the Phalen’s test, you might need an imaging test to take pictures of the inside of your wrist, hand or nerves, including:

• MRI (magnetic resonance imaging).
• Ultrasound.
• EMG (electromyogram).

If you have carpal tunnel syndrome, your provider will treat it. They’ll tell you which treatments you’ll need and what to expect. If you need surgery to repair damage inside your wrist, you’ll see an orthopaedist.

Does the Phalen’s test have any risks?

There aren’t any risks to either type of the Phalen’s test.

You might feel a little pain or discomfort during the test. But — even if you have carpal tunnel syndrome — the test is fast, and you can stop if you’re extremely uncomfortable. Tell your provider if any of the motions or positions in the test hurt.

What type of results will I get and what do they mean?

Your provider will classify your Phalen’s test results as positive or negative. A positive Phalen’s test means that you had some symptoms of carpal tunnel syndrome during the test. A negative Phalen’s test means you held the positions without experiencing any carpal tunnel syndrome symptoms.

Phalen’s test is usually very accurate, but there’s a chance you have carpal tunnel syndrome even if you have a negative Phalen’s test. Studies have found that the test is more than 85% accurate if you hold the hand position for more than a minute. However, Phalen’s test is only part of your overall physical exam. Tell your provider about when you notice symptoms and how severe they are.

What is the difference between Tinel’s sign and the Phalen’s test?

The Phalen’s test and Tinel’s sign are both in-office physical tests a healthcare provider might use to diagnose carpal tunnel syndrome in your wrist.

Phalen’s test is a series of hand motions and positions that will make your hands or fingers feel numb or tingly if you have carpal tunnel syndrome.

Tinel’s sign is a tingling feeling you get when your healthcare provider taps your skin over an affected nerve. If your provider thinks you have carpal tunnel syndrome, they’ll tap on your skin above the median nerve in your wrist. If that light pressure creates a tingling or “pins-and-needles” feeling in your fingers, you might have carpal tunnel syndrome or another form of nerve compression.

A note from Cleveland Clinic

The Phalen’s test is a quick, simple set of hand and wrist positions a healthcare provider will use to help diagnose carpal tunnel syndrome. You don’t have to do anything special to prepare, and the test itself is very fast. Visit a provider if you’re experiencing new wrist pain or notice symptoms like tingling or numbness in your hands or fingers.