Tinel's sign in the assessment of peripheral nerve regeneration is interpreted in which specific manner to track regenerating axons?

• A Tapping over the original nerve injury site producing pain indicates failed regeneration
• B Tinel's sign at the wrist indicates median nerve compression at the carpal tunnel regardless of prior injury
• C The advancing Tinel's sign (distal migration of the percussed tingling point along the nerve trunk over time) indicates actively advancing axonal regeneration ✓
• D Persistence of a fixed Tinel's sign for >6 months indicates complete neurotmesis and need for surgery

Explanation

Tinel's sign (percussion-induced paraesthesias or tingling) is clinically most useful for tracking peripheral nerve regeneration when assessed serially. As axonal sprouts advance distally from the injury site, the point at which percussion elicits tingling (the advancing Tinel's) moves distally at approximately 1 mm/day (or ~1 inch/month). This advancing Tinel's sign is evidence of active axonal regeneration. A stationary Tinel's sign at the injury level without distal advancement suggests failed regeneration or neuroma formation, which may warrant surgical intervention. This is distinct from Tinel's sign at the wrist for CTS, where it tests nerve compression rather than regeneration.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.