Diagnostic accuracy of the Hoffmann-Tinel sign for carpal tunnel syndrome: A systematic review and meta-analysis with comparison of techniques.

BACKGROUND

The Hoffmann-Tinel sign is used to diagnose and assess Carpal Tunnel Syndrome (CTS) but reported diagnostic accuracy varies widely, with multiple methods used to perform the test. This systematic review and meta-analysis compares the diagnostic accuracy of the Hoffmann-Tinel test when performed using fingertip percussion versus tendon hammer percussion, to establish the superior method which could standardise clinical practice.

METHODS

A diagnostic test accuracy systematic review using PubMed, Scopus and Embase (November 2025) identified studies that reported sensitivity/specificity data and the method of elicitation for the Hoffmann-Tinel sign in diagnosing CTS. Studies were grouped into fingertip percussion or tendon hammer percussion and compared using a bivariate random-effects model to generate pooled sensitivity, specificity, forest plots and summary receiver operating characteristic (SROC) curves. The review was registered on PROSPERO: CRD420251238061.

RESULTS

Sixteen studies involving 2471 participants were included. Nine studies (1322 participants) using tendon hammer percussion demonstrated a pooled sensitivity of 62.1% (95% CI [52.8%, 70.6%]) and pooled specificity 78.9% (95% CI [62.4%, 89.4]). Eight studies (1196 participants) using fingertip percussion demonstrated a pooled sensitivity of 40.0% (95% CI [30.9%, 49.8%]) and pooled specificity 86.1% (95% CI [70.8%, 94.0%]). Prediction intervals indicated substantial heterogeneity with diagnostic performance varied according to test method.

CONCLUSION

The diagnostic accuracy of the Hoffmann-Tinel sign for CTS is moderate when using tendon hammer percussion, but poor when using fingertip percussion. As the method of elicitation influences diagnostic accuracy, the method used should be standardised. The more accurate method of tendon hammer percussion should be preferred in clinical practice, with this being reflected in guideline recommendations.

LEVELS OF EVIDENCE: Therapeutic Level III, systematic review of Level II and III studies.