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.

Finkelstein Test Purposes

• With the thumb flexed and the other fingers flexed around it.
• The clinician grasps the patient’s hand, stabilizes the forearm with one hand, and then deviates the wrist to the ulnar side with the other hand (passive movement).
• Or it can be done with the patient deviates the hand to the ulnar side (active movement).

Finkelstein Test Positivity

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

No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of this test, so the results of this test must be interpreted with caution, as it may also be positive in Wartenberg syndrome (entrapment of the superficial radial sensory nerve), basilar thumb arthrosis, Extensor pollicis brevis EPB entrapment, or intersection syndrome.

Should be noted, before the Finkelstein test

• 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-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.

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

Reference

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