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Case Diagnosis: 39 year old male with bilateral hand paresthesia was diagnosed with right ulnar nerve entrapment proximal to the elbow. This was discovered with a Tinel sign along the ulnar nerve proximal to the cubital tunnel. Case Description: He was referred for an EMG for bilateral hand numbness and paresthesia. The symptoms were intermittent along the medial forearm and throughout the hands. Symptoms are often initiated by physical labor but can occur while sedentary. On exam his sensation and strength were normal. Negative Spurling, Phalen, and Tinel (at the wrist and the cubital tunnel) were noted. Because of the suspicion of ulnar neuropathy the Tinel was performed more proximally along the ulnar nerve. The Tinel was positive 5 cm proximal to the cubital tunnel. Because of this finding an inching technique was employed for the bilateral ulnar motor studies. The conduction velocity dropped to 25 m/s at the site positive Tinel. He was referred for ultrasound examination. Discussions: This patient's presentation and symptoms were consistent with a C8 radiculopathy versus ulnar neuropathy. Though his Tinel was negative at the elbow, a high suspicion of ulnar neuropathy was maintained. Because of this suspicion, further investigation of the ulnar nerve was performed with percussion. This finding guided the use of the inching technique which is not commonly performed at this institution. The patient was instructed to follow up for an ultrasound of the ulnar nerve with another physiatrist in this practice. Conclusions: The Tinel test is commonly used at the frequent sites of entrapment. If there continues to be a high suspicion of nerve entrapment the Tinel test can be used to localize entrapment along the accessible portions of the nerve. A positive Tinel at an uncommon location can help to guide further electrodiagnostics and imaging. [ABSTRACT FROM AUTHOR]