Tinel’s Test at the elbow assesses whether gentle tapping over the ulnar nerve region reproduces familiar tingling, paraesthesia or symptoms into the ulnar nerve distribution. A positive result may support suspicion of ulnar nerve irritability or cubital tunnel involvement, but it does not confirm cubital tunnel syndrome on its own. A recent expert consensus study identified a positive Tinel sign at the medial elbow as one of several agreed diagnostic criteria for cubital tunnel syndrome, alongside ulnar-distribution paraesthesia, symptoms with elbow flexion and motor or sensory findings.
A client reports tingling into the ring and little fingers, symptoms when the elbow is bent, hand weakness or discomfort around the inside of the elbow. They may notice symptoms when leaning on the elbow, cycling, driving, sleeping with the elbow flexed or performing repeated gripping tasks.
Tinel’s Test can help assess whether tapping over the ulnar nerve reproduces familiar symptoms. It should be interpreted with the client’s symptom distribution, elbow flexion response, sensory findings, motor findings and related upper-limb assessment.
Test name: Tinel’s Test at the Elbow
Also known as: Tinel Sign, Tinel’s Sign at the Cubital Tunnel
Body region: Ulnar nerve at the elbow
Purpose: Assess ulnar nerve irritability or symptom reproduction
Positive finding: Familiar tingling, paraesthesia or symptoms into the ulnar nerve distribution
Negative finding: No familiar symptoms with tapping
Best used with: Elbow flexion test, neurological screen, grip strength, pinch strength, Wartenberg’s Sign and upper limb neurodynamic testing
Key limitation: It does not confirm cubital tunnel syndrome on its own
Tinel’s Test involves gently tapping over a nerve to assess whether symptoms are reproduced. At the elbow, the test is usually performed over the ulnar nerve around the cubital tunnel behind the medial epicondyle.
The most meaningful response is familiar tingling, electric sensation, numbness or paraesthesia into the ulnar side of the hand, especially the ring and little fingers.
The test is used when ulnar nerve involvement is part of the assessment. It may help document nerve irritability and guide further assessment of elbow flexion symptoms, sensory changes, grip or pinch strength, intrinsic hand strength and referral needs.
Tinel’s Test assesses symptom response to percussion over the ulnar nerve region. It does not measure nerve conduction and does not confirm nerve compression.
Symptoms may be influenced by cubital tunnel irritation, local nerve sensitivity, cervical contribution, thoracic outlet involvement, peripheral nerve sensitivity, diabetes-related neuropathy or other neurological factors.
This test may be useful for clients with tingling, numbness or paraesthesia into the ring and little fingers, medial elbow symptoms, symptoms with elbow flexion, grip changes or suspected ulnar nerve involvement.
Use when symptoms suggest ulnar nerve involvement and gentle tapping over the medial elbow can be performed safely.
Use caution with acute trauma, severe nerve symptoms, marked hypersensitivity, recent surgery, open wounds, severe swelling, progressive neurological deficit or symptoms that remain aggravated after testing.
Pain and symptom scale
Measurz recording workflow
Optional sensory screen tools
Optional grip or pinch dynamometer
Optional referral notes
Position the client sitting with the elbow supported and relaxed.
The elbow may be slightly flexed with the forearm supported.
Sit or stand beside the tested elbow.
Locate the ulnar nerve region around the cubital tunnel behind the medial epicondyle.
Support the arm and avoid pressing aggressively into the nerve.
Gently tap over the ulnar nerve region.
Ask the client to report tingling, numbness, electric sensation, pain, symptom location and whether the symptom is familiar.
A positive Tinel’s Test is reproduction of familiar paraesthesia or symptoms into the ulnar nerve distribution.
A negative test is no familiar symptom reproduction.
Stop if symptoms increase sharply, tingling persists, pain is not tolerated or the client becomes distressed.
Do not tap aggressively or repeatedly. Record the distribution and duration of symptoms.
A positive Tinel’s Test may increase suspicion of ulnar nerve irritability or cubital tunnel involvement when it reproduces the client’s familiar symptoms into the ulnar nerve distribution. It does not confirm cubital tunnel syndrome on its own.
A positive response may also reflect local nerve sensitivity, cervical radicular symptoms, thoracic outlet contribution, peripheral neuropathy or heightened sensitivity. Interpretation is stronger when symptoms are consistent with ulnar nerve distribution and are supported by elbow flexion symptoms, sensory changes, motor findings, grip or pinch changes, Wartenberg’s Sign or electrodiagnostic findings where relevant.
A negative Tinel’s Test does not exclude cubital tunnel syndrome or ulnar neuropathy. Some clients may only develop symptoms with sustained elbow flexion, pressure, activity exposure or more advanced neurophysiological testing.
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for Tinel’s Test at the elbow as a stand-alone test appears limited.
A 2023 expert consensus study reported agreement that positive Tinel sign at the medial elbow is one of several clinical criteria for cubital tunnel syndrome, along with ulnar-distribution paraesthesia, symptoms with elbow flexion, motor or late findings, two-point discrimination loss and matching contralateral symptoms after successful treatment.
Condition or presentation: suspected cubital tunnel syndrome or ulnar neuropathy at the elbow
Population: expert consensus, not a diagnostic accuracy cohort
Test variation: percussion over medial elbow/ulnar nerve region
Reference standard: consensus criteria rather than imaging or electrodiagnostic reference standard
Sensitivity: not available from this source
Specificity: not available from this source
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: consensus evidence does not provide diagnostic accuracy values; Tinel’s Test should be interpreted with multiple clinical findings
Reliability depends on tapping location, tapping force, number of taps, elbow position, symptom criteria and whether the response follows the ulnar nerve distribution.
A 2020 review described cubital tunnel syndrome as a common compressive ulnar neuropathy requiring clinical evaluation and appropriate objective testing when needed.
Common errors include tapping too hard, treating local elbow tenderness as a positive nerve sign, not recording symptom distribution, failing to screen sensation and strength, and using Tinel’s Test alone to label cubital tunnel syndrome.
Limitations include symptom fluctuation, false positives, cervical or thoracic outlet contribution, peripheral neuropathy and limited stand-alone diagnostic accuracy evidence.
Use Tinel’s Test to document ulnar nerve symptom irritability and guide further nerve, strength, ergonomic, workload and referral decisions when appropriate.
Record the test name, side tested, result as positive, negative, unclear or unable to test, symptom intensity, symptom distribution, tapping location, number of taps if relevant, pain score, symptom quality, sensory symptoms, motor symptoms, comparison side, irritability, confidence in result and reason for stopping.
Add related findings such as elbow flexion response, grip strength, pinch strength, Wartenberg’s Sign, Froment-type findings if assessed, cervical screen, upper limb tension testing and referral notes.
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Elbow Flexion Test
Upper Limb Tension Test
Wartenberg’s Sign
Grip Strength Test
Pronator Teres Syndrome Test
Cervical ROM Tests
Thoracic Outlet Tests
Wrist Tinel’s Test
It assesses whether tapping over the ulnar nerve reproduces familiar tingling or paraesthesia.
A positive result is familiar symptoms into the ulnar nerve distribution, usually the ring and little fingers or ulnar side of the hand.
No. It may support suspicion, but it does not confirm cubital tunnel syndrome on its own.
No. Local tenderness should be recorded separately from nerve-distribution symptoms.
A negative result means tapping did not reproduce familiar symptoms. It does not fully exclude ulnar nerve involvement.
Record side, tapping location, symptom distribution, intensity, sensory or motor symptoms and related nerve findings.
Tinel’s Test at the elbow assesses ulnar nerve symptom irritability.
Familiar tingling into the ulnar distribution is more meaningful than local tenderness.
A positive test does not confirm cubital tunnel syndrome.
A negative test does not exclude ulnar nerve involvement.
Measurz should capture symptom distribution, intensity and related findings.
Dy, C. J., Mackinnon, S. E., Novak, C. B., & others. (2023). Cubital tunnel syndrome: Does a consensus exist for diagnosis? Journal of Hand Surgery. PMID: 37422755.
Nakashian, M. N., Ireland, D., & Kane, P. M. (2020). Cubital tunnel syndrome: Current concepts. Current Reviews in Musculoskeletal Medicine, 13(4), 520–524.
