View source for Phalen maneuver

{{Short description|Diagnostic test for carpal tunnel syndrome}}
{{Use American English|date=March 2021}}
{{Use mdy dates|date=March 2021}}
{{Infobox diagnostic
| name            = Phalen maneuver
| image           = Phalen's Maneuver.jpg
| alt             = 
| caption         = Phalen's maneuver
| pronounce       =  
| purpose         =test carpal tunnel syndrome
| test of         =
| based on        =
| synonyms        = 
| reference_range =
| calculator      = 
| DiseasesDB      = <!--{{DiseasesDB2|numeric_id}}-->
| ICD10           = <!--{{ICD10|Group|Major|minor|LinkGroup|LinkMajor}} or {{ICD10PCS|code|char1/char2/char3/char4}}-->
| ICD9            = 
| ICDO            =
| MedlinePlus     = <!--article_number-->
| eMedicine       = <!--article_number-->
| MeshID          = 
| OPS301          = <!--{{OPS301|code}}-->
| LOINC           = <!--{{LOINC|code}}-->
}}
[[Image:Carpal-Tunnel.svg|thumb|Transverse section across the wrist and digits. (The median nerve is the yellow dot near the center. The carpal tunnel is not labeled, but the circular structure surrounding the median nerve is visible.)]]

'''Phalen's maneuver''' is a diagnostic test for [[carpal tunnel syndrome]]<ref>{{DorlandsDict|nine/000955754|Phalen maneuver}}</ref> by an American [[orthopedist]] named [[George S. Phalen]].<ref name="pmid19279501">{{cite journal |vauthors=Sawaya RA, Sakr C |title=When is the Phalen's test of diagnostic value: an electrophysiologic analysis? |journal=J Clin Neurophysiol |volume=26 |issue=2 |pages=132–3 |date=April 2009 |pmid=19279501 |doi=10.1097/WNP.0b013e31819d8046 }}</ref>

==Technique==
The patient is asked to hold their [[Wrist|wrists]] in complete and forced [[flexion]] (pushing the dorsal surfaces of both hands together) for 30–60 seconds.  The [[Lumbricals of the hand|lumbricals]] attach in part to the [[Flexor digitorum profundus muscle|flexor digitorum profundus]] tendons.  As the wrists flex, the flexor digitorum profundus contracts in a [[anatomical terms of location#Relative directions|proximal]] direction, drawing the [[Lumbricals of the hand|lumbricals]] along with it. 

In some individuals, the lumbricals can be "dragged" into the carpal tunnel with flexor digitorum profundus contraction.  As such, Phalen's maneuver can moderately increase the pressure in the carpal tunnel via this mass effect, pinching the [[median nerve]] between the [[anatomical terms of location#Relative directions|proximal]] edge of the [[transverse carpal ligament]] and the anterior border of the distal end of the [[radius (bone)|radius]]. 

By compressing the [[median nerve]] within the [[carpal tunnel]], characteristic [[Carpal tunnel syndrome#Symptoms|symptoms]] (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) convey a positive test result and suggest carpal tunnel syndrome.  Because not all individuals will draw the lumbricals into the carpal tunnel with this maneuver, this test cannot be perfectly sensitive or specific for carpal tunnel syndrome.<ref>Urbano, F. (2000). Tinel's sign and Phalen's maneuver: Physical signs of carpal tunnel syndrome. ''Hospital Physician'', Jul, 39-44. ([http://turner-white.com/pdf/hp_jul00_tinel.pdf Retrieved 19:15:10 UTC Monday, December 15, 2008] {{Webarchive|url=https://web.archive.org/web/20140319182212/http://www.turner-white.com/pdf/hp_jul00_tinel.pdf |date=March 19, 2014 }}</ref>

==Accuracy==
In studies of diagnostic accuracy, the [[Sensitivity and specificity|sensitivity]] of the Phalen's maneuver ranged from 51% to 91% and its [[specificity (statistics)|specificity]] from 33% to 88%.{{citation needed|date=October 2012}}

==Reverse Phalen's test==
[[File:Reverse Phalen's Maneuver.jpg|thumb|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&nbsp;mm Hg.{{citation needed|date=October 2012}} The average pressure changes in the carpal tunnel for the reverse Phalen's test were 34&nbsp;mm Hg at one minute into the test and 42&nbsp;mm Hg at the two-minute point.{{citation needed|date=October 2012}}

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.<ref>{{cite journal |vauthors=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}}</ref> This is thought to add to the sensitivity of conventional screening methods.

==Comparison==
Phalen's maneuver is more [[Sensitivity (tests)|sensitive]] than [[Tinel's sign]].<ref>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.</ref>

==References==
{{reflist|2}}

{{Eponymous medical signs for nervous system}}
{{Orthopedic examination |state=autocollapse}}

[[Category:Eponyms in medicine]]
[[Category:Musculoskeletal examination]]
[[Category:Wrist]]