Finkelstein Test

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 Finkelstein Test


What is 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 do the Finkelstein Test?

What does a positive Finkelstein Test mean?

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.

Notes

Isolation of the Extensor Pollicis Brevis EPB tendon in a separate compartment has been reported to contribute to the pathogenesis of De Quervain disease.1

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

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.

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
1st extensor compartment

Reference

  1. Alexander RD, Catalano LW, Barron OA, et al: The extensor pollicis brevis entrapment test in the treatment of De Quervain’s disease. J Hand Surg Am 27:813–816, 2002.
  2. 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.
  3. 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/
  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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