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.
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, EPB entrapment, or intersection syndrome.
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 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 EPB lies in a separate sheath and was not released (EPB entrapment syndrome). This test has been found to have a sensitivity of 81% and a specificity of 50%.
Isolation of the EPB tendon in a separate compartment has been reported to contribute to the pathogenesis of de Quervain disease.1
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.
Differential Diagnosis include:
Arthritis of the first carpometacarpal joint,
Scaphoid fracture and nonunion
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.
Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.