How is Tinels sign of the elbow performed?

• A. Tap repeatedly over groove between olecranon process and medial epicondyle
• B. Tap over the medial epicondyle only
• C. Tap over the olecranon process
• D. Tap over the radial head

Answer: (A)

Tinel’s sign at the elbow is testing the ulnar nerve as it passes through the cubital tunnel. You percuss right in the groove between the olecranon and the medial epicondyle where the ulnar nerve runs behind the medial elbow. If the nerve is irritated or compressed there, tapping produces paresthesias along the ulnar distribution—usually the little finger and the medial half of the ring finger. A positive result points to ulnar neuropathy at the elbow, such as cubital tunnel syndrome, which can accompany elbow injuries or prolonged flexion. Other tapping sites won’t specifically test the ulnar nerve in its cubital tunnel location, or they may provoke non-specific pain or tap other nerves, so they’re less informative for this sign.