The test described is the Phalen test
A sewing machine operator has numbness and tingling of the thumb, index, and middle fingers of both hands. That distribution matches the sensory area of the median nerve, which is compressed at the wrist in carpal tunnel syndrome. The nurse has her press the backs of both hands together with the wrists fully flexed for 60 seconds, and the tingling returns. Holding the wrists flexed back-to-back to reproduce median nerve symptoms is the Phalen test. Flexing the wrist narrows the carpal tunnel and raises the pressure on the nerve, so a nerve that is already compressed reacts with tingling and numbness.
Why she is at risk
Carpal tunnel syndrome is linked to repetitive wrist flexion and extension, forceful gripping, and vibration, all of which are common in sewing work over long shifts. Other risk factors include pregnancy, diabetes, hypothyroidism, rheumatoid arthritis, and obesity. Symptoms are often worse at night, because people sleep with the wrists flexed, and may progress to weakness and wasting of the thenar muscles at the base of the thumb.
| Test | How it is done | What it detects |
|---|
| Phalen test | Wrists flexed back-to-back for 60 seconds | Carpal tunnel syndrome |
| Tinel sign | Tapping over the median nerve at the wrist | Carpal tunnel syndrome |
| Finkelstein test | Thumb folded into the fist, wrist bent toward the little finger | Tenosynovitis at the base of the thumb |
| Allen test | Compressing radial and ulnar arteries, then releasing one | Arterial flow to the hand |
Why the other tests are wrong
The Tinel sign is also used for carpal tunnel syndrome, which makes it the main distractor, but it is produced by tapping over the median nerve, not by holding the wrists flexed. The Finkelstein test stretches the thumb tendons and detects tenosynovitis at the base of the thumb. The Allen test checks whether the radial and ulnar arteries supply the hand, for example before arterial puncture.
Occupational health response
The occupational health nurse documents the findings, refers the worker for medical evaluation, and looks at the workstation: chair and table height, wrist position while sewing, rest breaks, and job rotation. Early treatment with splinting and activity changes can prevent progression to permanent nerve damage.
Exam takeaway
Key point Phalen = flexion held for 60 seconds; Tinel = tapping. Both reproduce median nerve symptoms in carpal tunnel syndrome.