The Phalen’s maneuver is often considered a first step to help diagnose potential carpal tunnel syndrome.

When diagnosing carpal tunnel syndrome (CTS), a doctor will need to perform different diagnostic tests to help rule out other conditions that may be causing your symptoms. The Phalen’s maneuver is one such test.

Also called the Phalen’s test, this noninvasive physical exam increases pressure within the carpal tunnel, which you’ll perform under a doctor’s guidance. Depending on the results, a doctor may diagnose CTS.

Learn more about the Phalen’s maneuver, including how it works, why doctors order it, and other important information about the procedure.

A doctor may perform the Phalen’s maneuver if they suspect that you have CTS.

CTS develops when there’s excess pressure on the median nerve inside your wrist. This can lead to symptoms such as tingling, numbness, and pain throughout the affected wrist, hand, and fingers. Symptoms can worsen with activities that put more pressure on the median nerve.

Although the symptoms of CTS are identifiable, it’s possible to mistake them for other conditions that affect your hands, such as arthritis. The Phalen’s test is just one way a doctor may help diagnose CTS while ruling out joint conditions.

A primary care doctor can diagnose CTS most of the time. In some cases, a hand surgeon may conduct the Phalen’s maneuver, as well as other CTS diagnostic testing.

Aside from primary care doctors and orthopedic surgeons, the following professionals can also sometimes diagnose CTS:

  • neurosurgeons
  • neurologists
  • physiatrists

Part of the reason why so many types of doctors may diagnose CTS is that no special equipment is needed. The key is asking whether the doctor is knowledgeable about diagnosing CTS, including tests like the Phalen’s maneuver.

The Phalen’s test involves hand and wrist movements that put pressure on the median nerve inside the carpal tunnel in your wrist. If you have CTS, you’ll likely feel discomfort during Phalen’s maneuver exercises.

Aside from mild discomfort, you shouldn’t expect any major risks associated with the Phalen’s maneuver. That being said, if you experience sharp pain during the test, tell your doctor so they can have you stop. Your symptoms should go away shortly after the test.

You can expect the following instructions from a doctor as they walk you through the Phalen’s test:

  1. First, a doctor will ask you to hold both of your wrists into forced flexion.
  2. Next, you’ll place the backs of your hands together. Your fingers will face downward toward the floor.
  3. You’ll need to hold this for about 30 to 60 seconds.
  4. After this, your doctor will ask you about any symptoms you might be experiencing.
  5. In particular, they’ll be interested to hear if you have numbness or tingling in your fingers after the exercise, as this could indicate problems with pressure in the carpal tunnel.
  6. After the test is over, your doctor will discuss next steps with you, including additional testing.

Although researchers don’t consider the Phalen’s test to always be accurate, it can help a hand surgeon determine the next steps based on your results.

Phalen’s test positive

A positive Phalen’s test means that you experienced classic symptoms of CTS after performing the maneuver. In such cases, you may feel tingling or numbness that extends up through your index finger, middle finger, and thumb.

Phalen’s test negative

A Phalen’s test negative result means that you don’t experience CTS symptoms and may not have CTS. However, a doctor may order other tests to help confirm these findings.

If a doctor suspects that you may have CTS, they may want to confirm a positive Phalen’s maneuver with additional tests. This may also help address any inaccuracies that are sometimes reported with Phalen’s testing, as well as rule out other conditions.

Possible next steps after a Phalen’s test include:

  • X-rays: X-rays can help a doctor rule out arthritis or fractures by providing pictures of your bones and joints.
  • Ultrasound: A doctor may order an ultrasound to help provide images of both the median nerve and the carpal tunnel in your wrist. Here, they’ll look for signs of swelling where the two meet.
  • Electromyography: During electromyography, a healthcare provider uses a series of electric signals to determine the presence of neuromuscular problems.
  • Nerve conduction study: This test also uses electric signals, but the purpose is to measure whether nerve signals are inhibited by a swollen carpal tunnel.
  • Blood tests: Additionally, a doctor may want to rule out potential nerve-damaging conditions like diabetic neuropathy or autoimmune conditions like rheumatoid arthritis.

Aside from the Phalen’s maneuver and appropriate follow-up testing, a doctor may consider the following types of in-office tests as part of your initial assessment.

Tinel test and sign

Formerly known as the Hoffman-Tinel sign, this is another type of test that may help a doctor diagnose peripheral nerve compression issues.

During this test, they’ll tap a finger over the suspected nerve (the median nerve) that’s causing issues. Like the Phalen’s test, Tinel’s sign requires further testing to confirm positive results.

Reverse Phalen’s test (Wormser’s test)

The purpose of the reverse Phalen’s test is similar to the traditional Phalen’s maneuver. You’ll hold your hands and wrists in a certain way for several seconds to see if light pressure on the median nerve results in any symptoms.

The difference is the positioning of your hands. Instead of flexing your wrists with your fingers pointing downward, you’ll push the palms of your hands together while your fingers point up toward the ceiling.

Carpal compression (Durkan’s test)

During a carpal compression test, a doctor asks you to flex your wrist while they put slight pressure on your median nerve.

Your arm will rest on an examination table, with the back of your hand placed against it and your palm facing up. Again, the purpose is to see whether you develop symptoms after several seconds.

It’s important to contact a doctor if you’re experiencing possible symptoms of CTS. Avoid trying to self-diagnose this condition at home. Getting a correct diagnosis can help you get the treatment you need and could help reduce the risk of further complications.

More than likely, a doctor will want to confirm a positive Phalen’s test with imaging and nerve signal testing.