Phalen's test is the wrist flexion manoeuvre used to provoke the symptoms of carpal tunnel syndrome. Holding the wrist in full flexion raises pressure inside the carpal tunnel; if the median nerve is already compressed, that extra pressure reproduces the patient's numbness and tingling within about a minute.
It is quick, needs no equipment, and is one of the most widely taught orthopaedic special tests, but on its own it is not accurate enough to rule carpal tunnel syndrome in or out. This reference covers how to perform it properly and how it compares with the other provocative tests you would use alongside it.
Zdrovia: https://www.zdrovia.ca/resources/phalens-test/
Orthopaedic Test
Carpal Tunnel Provocative Test Comparator
Technique, positive finding, and reported accuracy for the five manual tests, plus a check on whether the symptom pattern actually fits the median nerve.
Check the symptom pattern
Phalen's test
Position
Elbow on the table, forearm vertical, wrist allowed to drop into full unforced flexion. Classically performed by pressing the dorsal surfaces of both hands together with the fingers pointing down, which flexes both wrists at once and lets you compare sides.
Hold for
60 seconds
Mechanism
Sustained flexion raises pressure inside the carpal tunnel.
Positive finding
Numbness, tingling, or paraesthesia reproduced in the median distribution: thumb, index, middle, and radial half of the ring finger.
Reported sensitivity
57% (44–68)
95% CI or study range
Reported specificity
67% (52–79)
95% CI or study range
Your findings
Record whether symptoms were reproduced to see an interpretation.
All five tests compared
| Test | Manoeuvre | Hold | Sensitivity | Specificity |
|---|---|---|---|---|
| Phalen's test | Wrist flexion | 60 seconds | 57% (44–68) | 67% (52–79) |
| Reverse Phalen's test | Wrist extension | 60 seconds | 69%* | 96%* |
| Tinel's sign | Percussion | 4–6 taps | 45% (34–57) | 78% (60–89) |
| Carpal compression (Durkan's) | Direct pressure | 30 seconds | 36–86%* | 33–62%* |
| Hand elevation test | Elevation | 1–2 minutes | Limited* | Limited* |
These results are estimates based on published clinical data and are for informational purposes only. They do not constitute medical advice, a diagnosis, or a treatment recommendation. Interpret results with a qualified healthcare professional and alongside a comprehensive clinical assessment.
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Zdrovia's smart blocks put provocative test results, side, and time to onset into the chart as structured fields you can search later.
How to perform Phalen's test
Seat the patient with the elbow resting on a table and the forearm vertical. Ask them to let the wrist drop into full unforced flexion; the classic method is to press the dorsal surfaces of both hands together with the fingers pointing down, which flexes both wrists simultaneously and lets you compare sides.
Hold the position for 60 seconds and ask the patient to report what they feel and where. A positive test is the reproduction of numbness, tingling, or paraesthesia in the median nerve distribution: the thumb, index finger, middle finger, and the radial half of the ring finger. Pain alone is not a positive result, and neither is numbness in the little finger, which is ulnar territory.
Record how long symptoms take to appear because it provides useful documentation for the selected test protocol. Do not treat onset time as a validated severity grade; severity assessment requires the broader clinical picture and, where indicated, electrodiagnostic testing.
How accurate is it?
A 2023 systematic review and meta-analysis reported pooled sensitivity of 57% and specificity of 67% for Phalen's test. For Tinel's sign, pooled sensitivity was 45% and specificity was 78%. Estimates for the other provocative manoeuvres were based on fewer or conflicting studies.
The practical consequence is that no single provocative test settles the question. A negative Phalen's does not exclude carpal tunnel syndrome, and a positive one in isolation does not confirm it. Clustering tests (and weighing them against the history, the pattern of symptoms, and where appropriate nerve conduction studies) is what actually moves the diagnosis.
The comparator therefore shows pooled estimates with confidence intervals where available and flags manoeuvres supported by less evidence. Treat the figures as population-level evidence, not precise operating characteristics for an individual patient.
Documenting provocative tests properly
A test result recorded as 'Phalen's positive' is much less useful six weeks later than one recorded as 'Phalen's positive at 25 seconds, tingling thumb through radial ring finger, right hand; negative left'. The second version tells you whether the patient is improving; the first does not.
Capture the manoeuvre, the time to onset, the distribution of symptoms, and the side. Structured fields do this more reliably than free text, because they prompt for the same details every time and make the results comparable across visits and between practitioners in the same clinic.