Wrist & Hand Assessment

Finkelstein Test | De Quervain's Tenosynovitis Assessment | Thumb Pain

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Finkelstein Test

Finkelstein Test | De Quervain’s Tenosynovitis Assessment | Thumb Pain

De Quervain’s tendinitis, also known as gamer’s thumb or blackberry thumb is the inflammation of the synovial sheath that surrounds the tendon of the extensor pollicis brevis and abductor pollicis longus.

The Finkelstein test is the hallmark test to diagnose this pathology, although no values on validity are known. So the clinical value of this test is questionable.

To perform the test, Dawson et al. from the year 2010 recommend a 3-stage process, which is well-tolerated and able to diagnose the de Quervain’s tendinitis accurately:

To perform the test, have your patient’s affected extremity extended so that the wrist remains at the edge of the treatment table. The arm is positioned with the ulnar aspect of the forearm on the table and the ulnar aspect of the hand hanging off the edge. The forearm is maintained in neutral.

In the first step, the patient’s pain is assessed with gravity-assisted gentle active ulnar deviation at the wrist. This version is suitable for patients who present in the acute phase. This test is positive if patients report pain aggravation at the tip of the styloid process.

If version one does not elicit pain, gently apply an ulnar deviation force to the hand, which results in an increased passive stretch across the first dorsal compartment. Again, this test is positive, if the patient reports aggravated pain over the styloid process.

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 the Eichhoff’s Test that 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 Eichhoff’s Test.

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References

Dawson C, Mudgal CS. Staged description of the Finkelstein test. The Journal of hand surgery. 2010 Sep 1;35(9):1513-5.

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

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