Eichhoff's Test | De Quervain's tendinitis

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Eichhoff’s Test | De Quervain’s tendinitis | Gamer’s Thumb

In the literature, there is a lot of confusion regarding the original version of the Finkelstein test. Elliot (1992) states that “Over the last three decades an error in performing Finkelstein’s test has crept into the English literature in both textbooks and journals. This error can produce a false-positive, and if relied upon, a wrong diagnosis can be made, leading to inappropriate surgery.” The error that has crept into the literature is actually Eichhoff’s test.

Goubeau et al. (2014) have evaluated this test regarding its accuracy to diagnose de Quérvain’s disease and found a sensitivity of 89% and a specificity of 14%. As this is the only study evaluating this test so far, its clinical value remains questionable.

To perform this test, have your patient extend his affected extremity and rest it on the treatment table so that the wrist is hanging off of the table.

Then ask him to make a fist with the thumb inside his fist, stabilize the forearm on the table and gently deviate the wrist towards the ulnar side.

This test is positive if your patient experiences pain over the tendons of the extensor pollicis brevis and the abductor pollicis longus, which both form the medial base of the anatomical sniff box.

Due to its very provocative nature, the Eichhoffs’ test can cause a lot of false positives, which is why we recommend to rather perform the original version of the Finkelstein test, which you can watch by a click on the video right next to me.

If the second step is still not provocating, we will perform the original version described by Finkelstein et al., which is suitable for patients in the chronic stage that present is likely to not have substantial pain in the first two steps. In this third step, grasp the thumb and passively flex into the palm. A positive test result is recorded if the patient experiences increased pain over the tip of the styloid process.

Performing the test in this staged manner is hypothesized to create less false-positive results as it is less provocative than Eichhoff’s Test whch is often confused with the Finkelstein test in the literature. Click on the video right next to me to watch this test

Another orthopedic test for De Quérvain’s Disease is the Wrist Hyperflexion Abduction (WHAT) Test.

References

Elliott BG. Finkelstein’s test: a descriptive error that can produce a false positive. Journal of hand Surgery. 1992 Aug;17(4):481-2.

Wu, F., Rajpura, A., & Sandher, D. (2018). Finkelstein’s test is superior to Eichhoff’s test in the investigation of de Quervain’s disease. Journal of hand and microsurgery, 10(02), 116-118.

Goubau, J. F., Goubau, L. A. U. R. E. N. T., Van Tongel, A., Van Hoonacker, P., Kerckhove, D., & Berghs, B. (2014). The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. Journal of Hand Surgery (European Volume), 39(3), 286-292.

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