Phalen’s Test assesses whether sustained wrist flexion reproduces median nerve distribution symptoms. It is commonly used in suspected carpal tunnel syndrome, but diagnostic accuracy varies between studies. A 2020 study of provocative tests using electrodiagnostic testing as the reference standard found that the wrist flexion test had moderate sensitivity and specificity, while a 2021 systematic review emphasised that diagnostic test accuracy varies across sensory and motor tests.
A client reports numbness, tingling or burning into the thumb, index, middle finger or radial half of the ring finger. Symptoms may occur at night, during driving, phone use, typing or gripping.
Phalen’s Test can help assess whether sustained wrist flexion reproduces familiar median nerve symptoms. It should be interpreted with symptom distribution, night symptoms, grip or pinch changes, sensory testing, Tinel’s at the wrist and clinical reasoning.
Test name: Phalen’s Test
Also known as: Wrist Flexion Test
Body region: Wrist, carpal tunnel, median nerve
Purpose: Assess median nerve symptom response to sustained wrist flexion
Positive finding: Familiar numbness, tingling or paraesthesia in the median nerve distribution
Negative finding: No familiar symptoms during the test duration
Best used with: Wrist Tinel’s, sensory testing, grip strength, pinch strength, CTS-6-type reasoning and upper limb neurodynamic testing
Key limitation: A positive result does not diagnose carpal tunnel syndrome on its own
Phalen’s Test is a carpal tunnel provocation test. The wrists are held in flexion for a set time, commonly up to 60 seconds, while symptoms are monitored.
The test is positive when it reproduces familiar median nerve symptoms, not simply wrist discomfort.
The test is used when carpal tunnel syndrome or median nerve irritation at the wrist is suspected.
It may be relevant in clients with hand paraesthesia, night symptoms, gripping symptoms, desk work symptoms, cycling symptoms or wrist-position-related symptoms.
Phalen’s Test assesses symptom response to sustained wrist flexion. It does not directly measure median nerve compression or confirm carpal tunnel syndrome.
Symptoms may be influenced by cervical radiculopathy, pronator syndrome, peripheral neuropathy, wrist joint pain, tendon irritation or general nerve sensitivity.
This test may be useful for clients with median nerve distribution symptoms, nocturnal hand symptoms, grip complaints, work-related wrist symptoms or symptoms influenced by wrist position.
Use when median nerve symptoms are part of the clinical reasoning and sustained wrist flexion is safe and tolerated.
Use caution with acute wrist trauma, severe pain, recent surgery, progressive neurological deficit, marked swelling or symptoms that remain aggravated after testing.
Timer
Pain and symptom scale
Measurz recording workflow
Optional sensory testing tools
Optional grip or pinch dynamometer
Position the client sitting.
Ask the client to place the backs of the hands together or otherwise hold both wrists in flexion, depending on the selected method.
Observe hand and wrist position and monitor symptoms.
Manual contact is usually not needed unless helping the client maintain position.
Keep the shoulders relaxed and avoid excessive pressure between the hands.
Hold wrist flexion for up to the selected time, commonly 60 seconds.
Ask the client to report tingling, numbness, burning, symptom location, time to symptom onset and whether symptoms are familiar.
A positive Phalen’s Test is reproduction of familiar median nerve distribution symptoms.
A negative test is no familiar median nerve symptoms during the test duration.
Stop if symptoms become intense, persist, spread, or the client cannot tolerate the position.
Record time to symptom onset and distribution.
A positive Phalen’s Test may increase suspicion of carpal tunnel syndrome when it reproduces familiar symptoms in the median nerve distribution and matches the history. It does not confirm CTS on its own.
A positive response may also be seen with proximal median nerve involvement, cervical symptoms, peripheral neuropathy or general neural sensitivity.
A negative test may reduce suspicion under the tested conditions, but it does not exclude CTS, particularly when symptoms occur mainly at night, during repetitive tasks or under sustained loading.
A 2020 study comparing provocative CTS tests against electrodiagnostic testing found wrist flexion testing had moderate diagnostic performance; the study noted that previous CTS test accuracy research has been affected by bias and that no single provocative test should be interpreted alone.
Condition or presentation: suspected carpal tunnel syndrome
Population: people being assessed for CTS
Test variation: wrist flexion/Phalen-type testing
Reference standard: electrodiagnostic testing in the 2020 study
Sensitivity: varies between studies; moderate in the 2020 provocative-test study
Specificity: varies between studies; moderate in the 2020 provocative-test study
Positive likelihood ratio: varies by study and threshold
Negative likelihood ratio: varies by study and threshold
Key limitations: variable test duration, symptom criteria, reference standards and spectrum of CTS severity
A 2021 systematic review searched diagnostic accuracy literature up to January 2020 and found that accuracy estimates for sensory and motor CTS tests vary substantially. It also reported strong likelihood ratio ranges for CTS-6 compared with less useful tools, supporting combined clinical reasoning rather than one provocative test alone.
Reliability depends on wrist angle, duration, symptom criteria, bilateral versus unilateral method and whether median nerve distribution symptoms are specifically recorded.
Validity improves when the result is interpreted alongside symptom history, sensory testing, motor testing and validated clinical reasoning tools rather than alone.
Common errors include treating wrist discomfort as positive, not timing symptom onset, failing to record symptom distribution, using excessive pressure and diagnosing CTS from Phalen’s Test alone.
Limitations include variable sensitivity and specificity, symptom overlap, proximal nerve contribution and false positives.
Use Phalen’s Test to document wrist-position-related median nerve symptoms and compare findings with Tinel’s, sensory testing, grip/pinch strength and upper limb neurodynamic testing.
Record test name, side tested, result, wrist position, duration held, time to symptom onset, symptom distribution, symptom intensity, pain score, comparison side, symptom resolution time, related sensory or motor findings and reason for stopping.
Add wrist Tinel’s, grip strength, pinch strength, upper limb tension testing, pronator teres testing and cervical screen findings.
Wrist Tinel’s Test
Pronator Teres Syndrome Test
Upper Limb Tension Test I
Grip Strength Test
Wartenberg’s Sign
Allen Test
Arm Squeeze Test
Cervical ROM Tests
It assesses whether sustained wrist flexion reproduces median nerve distribution symptoms.
A positive result is familiar numbness, tingling or paraesthesia in the median nerve distribution.
No. It may support suspicion but does not diagnose CTS on its own.
Not necessarily. The key finding is familiar median nerve symptoms.
Record wrist position, duration, symptom onset time, symptom distribution, intensity and related findings.
Phalen’s Test is a median nerve wrist flexion provocation test.
Familiar median nerve symptoms are more meaningful than wrist discomfort.
Diagnostic accuracy varies between studies.
Use it with sensory, motor, Tinel’s and history findings.
Measurz should capture duration, symptom onset, distribution and comparison side.
Dabbagh, A., MacDermid, J. C., Yong, J., Packham, T. L., & Grewal, R. (2021). Diagnostic accuracy of sensory and motor tests for the diagnosis of carpal tunnel syndrome: A systematic review. BMC Musculoskeletal Disorders, 22, 337.
Żyluk, A., & colleagues. (2020). Accuracy of provocative tests for carpal tunnel syndrome. Journal of Hand Surgery Global Online.
