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Special Test

Finkelstein Test

Finkelstein Test is used to test for De Quervain’s tenosynovitis of the 1st extensor compartment of the wrist. It was described by Harry Finkelstein (an American surgeon) in 1930.

How do you perform Finkelstein test?

With the thumb flexed and the other fingers flexed around it (make a fist around the thumb), the clinician asks the patient to perform ulnar deviation to the hand.

A modified version of Finkelstein’s test is that the patient must sit comfortable and relaxed on the examination table. The patient holds his hand in the air. The clinician asked the patient to actively ulnarly deviate the wrist before grasping the patient’s thumb and passively flexing it into the palm.

Another similar test is Eichhoff’s test, it is performed by asking the participant to place the thumb within the hand and clench tightly with the other fingers. The hand was then passively abducted ulnarward by the examiner. 

In both the tests, the examiner can also perform these maneuvers while palpating the abductor pollicis longus and extensor pollicis brevis tendons over the lateral radius and feeling for moving nodularity, tendon rub, or popping directly over the tendon. 

See Also: De Quervain’s tenosynovitis Injection

What is a positive Finkelstein test?

Pain and crepitation above the radial styloid suggest nonspecific tenosynovitis of the abductor pollicis longus APL and the extensor pollicis brevis EPB.

Finkelstein Test accuracy

In one study that compared Finkelstein test vs Eichhoff’s test releability, the Finkelstein’s test was more specific than Eichhoff’s test, with a specificity of 100%, compared with 89% for Eichhoff’s test.

Notes

  • This test may create pain in uninvolved tissues. The examiner may also find that simple passive ulnar deviation may be slightly uncomfortable for even those without pathology. If de Quervain’s disease is suspected, but pain is not found with ulnar deviation, then the examiner can have the subject radially deviate against resistance in an attempt to reproduce contractile associated pain.
  • It is important to differentiate stenosing tenosynovitis (de Quervain’s disease) from osteoarthritis in the carpometacarpal joint of the thumb.
  • Specific examination of the carpometacarpal joint of the thumb and a radiograph will allow a quick differential diagnosis.
  • The Finkelstein test should also be performed on both sides for comparison.
  • Deviating the wrist using pressure over the index metacarpal avoids confusion with thumb conditions.
  • A variation of Finkelstein Test can be used to rule out an incomplete release of previous de Quervain disease. If the usual Finkelstein’s Test is positive, full abduction of the Abductor pollicis longus (APL) followed by flexion of the thumb’s MCP joint will isolate the action of the EPB. Pain with this test will occur if the Extensor pollicis brevis tendon lies in a separate sheath and was not released (Extensor pollicis brevis muscle EPB entrapment syndrome). This test has been found to have a sensitivity of 81% and a specificity of 50%.

Isolation of the Extensor Pollicis Brevis EPB tendon in a separate compartment has been reported to contribute to the pathogenesis of de Quervain disease.

Muckard Test

Muckard Test is another test used for diagnosis of acute or chronic tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (stenosing tenosynovitis or de Quervain’s disease).

The patient “tilts” the hand into ulnar deviation at the wrist with the fingers extended and the thumb adducted.

Severe pain in the radial styloid radiating into the thumb and forearm suggests tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons.

Muckard Test
Muckard Test

De Quervain’s Tenosynovitis

De Quervain tenosynovitis described by the presence of pain along the radial aspect of the wrist that worsens with radial and ulnar wrist deviation; pain on performing Finkelstein maneuver is pathognomonic.

Tenosynovitis is the result of inflammation of the synovial tissue, which is often caused by overuse or inflammatory rheumatoid disorders. However, blunt trauma can also lead to these disorders.

De Quervain differential Diagnosis include:

  1. Arthritis of the first carpometacarpal joint,
  2. Scaphoid fracture and nonunion
  3. Radiocarpal arthritis
  4. Wartenberg syndrome
  5. Intersection syndrome
1st extensor compartment

Reference

  1. LIPSCOMB PR. Stenosing tenosynovitis at the radial styloid process (de Quervain’s disease). Ann Surg. 1951 Jul;134(1):110-5. doi: 10.1097/00000658-195107000-00013. PMID: 14838546; PMCID: PMC1802681.
  2. Som A, Wermuth HR, Singh P. Finkelstein Sign. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539768/
  3. Wu F, Rajpura A, Sandher D. Finkelstein’s Test Is Superior to Eichhoff’s Test in the Investigation of de Quervain’s Disease. J Hand Microsurg. 2018 Aug;10(2):116-118. doi: 10.1055/s-0038-1626690. Epub 2018 Mar 20. PMID: 30154628; PMCID: PMC6103758. Pubmed
  4. Arons MS. de Quervain’s release in working women: a report of failures, complications, and associated diagnoses. J Hand Surg Am. 1987 Jul;12(4):540-4. doi: 10.1016/s0363-5023(87)80204-6. PMID: 2956316.
  5. Saplys R, Mackinnon SE, Dellon LA: The relationship between nerve entrapment versus neuroma complications and the misdiagnosis of de Quervain’s disease. Contemp Orthop 15:51, 1987.
  6. Williams JG: Surgical management of traumatic noninfective tenosynovitis of the wrist extensors. J Bone Joint Surg Br 59B:408, 1977.
  7. Louis DS: Incomplete release of the forst posterior (dorsal) compartment – a diagnostic test. J Hand Surg Am 12A:87, 1987.
  8. Clinical Tests for the Musculoskeletal System 3rd Edition.
  9. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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