Assesses for carpal tunnel syndrome.

  • Prayer Test

  • Symptoms of median nerve neuropathy

Patient Position
  • Sitting or standing
Examiner Position
  • Sitting or standing
Steps of Performance
  1. The patient places the palmar surfaces of both hands together in a prayer-like position and then elevates the elbow in relation to the wrists to increase wrist extension
  2. This position is held for up to 1 minute, or until neuropathy-type symptoms appear
Alternative Methods
  1. The patient places the palmar surfaces of both hands together with fingers pointing inferiorly. Palms are kept in full contact with each other while the wrists are elevated in relation to the elbows, increasing wrist extension

The median nerve travels through the carpal tunnel at the wrist in order to provides sensory innervation to the palmar side and tips of the first 3 ½ digits of the hand. Performing Reverse Phalen’s Test results in deep extension of both wrists, narrowing the carpal tunnel and placing pressure on the median nerve as it passes through the carpal tunnel. If the median nerve is inflamed, prolonged wrist extension can distinctly compromise median nerve conduction, resulting in neuropathic symptoms distal to the point of irritation along the nerve distribution.

General

Positives

Paresthesia or Numbness in the First 3 ½ Digits of the Hand

  • carpal tunnel syndrome
    • median nerve pathology

Pertinent Negatives

DATA
TAGS
References
Magee DJ. Orthopedic Physical Assessment. 6th edition. Elsevier; 2014.
Sevy JO, Varacallo M. Carpal Tunnel Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed August 27, 2023. http://www.ncbi.nlm.nih.gov/books/NBK448179/
Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. Mosby/Elsevier; 2010.
Werner RA, Bir C, Armstrong TJ. Reverse Phalen’s maneuver as an aid in diagnosing carpal tunnel syndrome. Arch Phys Med Rehabil. 1994;75(7):783-786.

Assesses for carpal tunnel syndrome.

  • Symptoms of median nerve neuropathy

Patient Position
  • Sitting or standing
Examiner Position
  • Sitting or standing
Steps of Performance
  1. The patient places the palmar surfaces of both hands together in a prayer-like position and then elevates the elbow in relation to the wrists to increase wrist extension
  2. This position is held for up to 1 minute, or until neuropathy-type symptoms appear
Alternative Methods
  1. The patient places the palmar surfaces of both hands together with fingers pointing inferiorly. Palms are kept in full contact with each other while the wrists are elevated in relation to the elbows, increasing wrist extension

The median nerve travels through the carpal tunnel at the wrist in order to provides sensory innervation to the palmar side and tips of the first 3 ½ digits of the hand. Performing Reverse Phalen’s Test results in deep extension of both wrists, narrowing the carpal tunnel and placing pressure on the median nerve as it passes through the carpal tunnel. If the median nerve is inflamed, prolonged wrist extension can distinctly compromise median nerve conduction, resulting in neuropathic symptoms distal to the point of irritation along the nerve distribution.

General

Positives

Paresthesia or Numbness in the First 3 ½ Digits of the Hand

  • carpal tunnel syndrome
    • median nerve pathology

Pertinent Negatives