# Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release*

## TL;DR

This study examines how the Phalen test and Tinel sign help predict recovery and improve quality of life after surgery for carpal tunnel syndrome.

## Contribution

The study provides new insights into the prognostic value of the Phalen test and Tinel sign in postoperative recovery for carpal tunnel syndrome.

## Key findings

- The Phalen test showed faster remission compared to the Tinel sign in the early postoperative period.
- Both tests became favorable prognostic indicators for clinical recovery and improved quality of life after the second postoperative week.
- Surgical treatment significantly reduced symptom severity and functional impairment scores on the Boston Carpal Tunnel Questionnaire.

## Abstract

Objective:
 To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach.

Methods:
 The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment.

Results:
 The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95%CI]: 1.16%–8.17%), 0.88% (95%CI: 0.08%–4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%–19.18% ), 4.42% (95%CI : 1.65%–9.36%) and 2.65% (95%CI : 0.70%–6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity (
p
 < 0.001) and of 1.6 points for functional status (
p
 < 0.001).

Conclusion:
 Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.

Objetivo:
 Avaliar a utilidade do teste de Phalen e do sinal de Tinel no prognóstico e o impacto na qualidade de vida no curso clínico de pacientes com síndrome do túnel do carpo submetidos ao tratamento cirúrgico por via aberta clássica.

Métodos:
 Trata-se de um estudo de coorte sobre prognóstico. Foram incluídos 115 pacientes com alta probabilidade de diagnóstico clínico de síndrome do túnel do carpo com indicação de tratamento cirúrgico. Todos os pacientes foram submetidos ao teste de Phalen e ao sinal de Tinel, e responderam ao questionário de Boston antes e depois do tratamento cirúrgico.

Resultados:
 As estimativas de probabilidade do tempo até a remissão do teste de Phalen em 2, 4 e 16 semanas pós-operatórias foram de 3,54% (intervalo de confiança de 95% [IC95%]:1,16%–8,17%), 0,88% (IC95%: 0,08%–4,38%) e 0,88% (IC95%: 0,08%–4,38%), respectivamente, e, do sinal de Tinel, foram de 12,39% (IC95%: 7,13%–19,18%), 4,42% (IC95%: 1,65%–9,36%) e 2,65% (IC95%: 0,70%–6,94%), respectivamente. Na pontuação pós-operatória no Questionário de Boston, houve redução de 1,8 ponto para a gravidade dos sintomas (
p
 < 0,001), e de 1,6 ponto para o estado funcional (
p
 < 0,001).

Conclusão:
 A remissão do teste de Phalen foi mais precoce do que a do sinal de Tinel, mas, realizados a partir da segunda semana de evolução pós-operatória, esses testes foram fatores prognósticos favoráveis ao curso clínico, com melhora da qualidade de vida.