Finkelstein Test | How to Perform, Positive Test & Accuracy

The Finkelstein Test is a commonly used clinical examination maneuver to diagnose De Quervain’s tenosynovitis, a stenosing tenosynovitis affecting the first extensor compartment of the wrist. This compartment contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.

The test was first described in 1930 by Harry Finkelstein, an American surgeon, and remains one of the most reliable physical tests for De Quervain’s disease.

What is the Finkelstein Test Used For?

The Finkelstein Test is used to:

• Assess pain over the radial styloid
• Identify inflammation of the APL and EPB tendons
• Differentiate De Quervain’s tenosynovitis from other causes of radial wrist pain

How Do You Perform the Finkelstein test?

Standard Finkelstein Test

1. The patient flexes the thumb into the palm.
2. The fingers wrap around the thumb, forming a fist.
3. The clinician then instructs the patient to ulnarly deviate the wrist.

Pain elicited over the radial aspect of the wrist suggests a positive Finkelstein Test.

Modified Finkelstein Test

In the modified version:

1. The patient sits comfortably with the forearm unsupported.
2. The patient actively ulnarly deviates the wrist.
3. The clinician then grasps the thumb and passively flexes it into the palm.

This version is often better tolerated and may reduce false-positive results.

Finkelstein Test vs Eichhoff’s Test

Eichhoff’s Test is often confused with the Finkelstein Test and is performed by:

• Placing the thumb inside the palm
• Clenching the fingers tightly
• The examiner passively ulnarly deviates the wrist while stabilizing the forearm

Although similar, Eichhoff’s test tends to produce more discomfort, even in asymptomatic individuals.

Palpation During the Finkelstein Test

During either maneuver, the examiner may palpate over the APL and EPB tendons at the lateral radius to assess for:

• Tendon crepitus
• Nodularity
• Tendon snapping or popping

See Also: De Quervain’s tenosynovitis Injection

What Is a Positive Finkelstein Test?

A positive Finkelstein Test is defined by:

• Sharp pain
• Crepitation
• Tenderness directly over the radial styloid

This pain indicates tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons.

Because the maneuver may cause discomfort in healthy individuals, comparison with the unaffected side is essential. The test is considered positive only if the patient’s typical symptoms are reproduced.

Finkelstein Test accuracy

A study comparing the Finkelstein Test and Eichhoff’s Test found that:

• Finkelstein Test specificity: 100%
• Eichhoff’s Test specificity: 89%

This supports the Finkelstein Test as the more specific examination for De Quervain’s disease.

Clinical Notes and Examination Tips

• Mild discomfort during ulnar deviation can occur in normal wrists.
• If De Quervain’s disease is suspected but pain is absent, ask the patient to radially deviate the wrist against resistance.
• Always perform the Finkelstein Test bilaterally for comparison.
• Applying pressure over the index metacarpal during deviation helps avoid confusion with thumb joint pathology.

EPB Entrapment and Incomplete Release Test

A variation of the Finkelstein Test can help identify incomplete surgical release in patients with persistent symptoms:

1. Fully abduct the abductor pollicis longus (APL).
2. Flex the thumb MCP joint to isolate the extensor pollicis brevis (EPB).

Pain during this maneuver suggests EPB entrapment in a separate sheath, known as EPB entrapment syndrome.

• Specificity: 50%
• Sensitivity: 81%

Muckard Test

The Muckard Test is another examination used to diagnose acute or chronic De Quervain’s tenosynovitis.

How to Perform the Muckard Test:

• Fingers extended
• Thumb adducted
• The patient actively ulnarly deviates the wrist

Severe pain over the radial styloid radiating into the thumb or forearm indicates inflammation of the APL and EPB tendons.

De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis presents as pain along the radial wrist that worsens with:

• Radial deviation
• Ulnar deviation
• Performing the Finkelstein Test (often pathognomonic)

It results from synovial inflammation, commonly due to:

• Repetitive overuse
• Rheumatoid or inflammatory conditions
• Blunt trauma

Differential Diagnosis of Radial Wrist Pain

Conditions to differentiate from De Quervain’s disease include:

• First carpometacarpal (CMC) joint osteoarthritis
• Scaphoid fracture or nonunion
• Radiocarpal arthritis
• Wartenberg syndrome
• Intersection syndrome

Radiographic imaging and targeted joint examination aid in diagnosis.

FAQ

Reference

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