Finkelstein's test

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An example of a modified Eichoff maneuver. Arrow marks were the pain is worsened.
Eichhoff's test for DeQuervain's tenosynovitis
The classic Finkelstein's test

Finkelstein's test and Eichoff maneuver, are similar tests used to diagnose de Quervain's tenosynovitis in people who have wrist pain.[1] The tests are typically described as the examiner grasping and ulnar deviating the hand when the person has their thumb held within their fist.[2] If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain's tenosynovitis is likely.[3]

Classical descriptions of the Finkelstein's test are when the examiner grasps the thumb and ulnar deviates the hand sharply.[1] Eichhoff's test is commonly confused with Finkelstein's test.[1] However the Eichhoff's test may produce false positive results, while a Finkelstein's test performed by a skilled practitioner is unlikely to produce a false positive.[4]

Purpose[edit]

Finkelstein's test is one way to determine if there is tenosynovitis in the abductor pollicis longus and extensor pollicis brevis tendons of the wrist. These two tendons belong to the first dorsal compartment.

History[edit]

Finkelstein's test was described by Harry Finkelstein (1865–1939), an American surgeon, in 1930.[5] A similar test was previously described by Eichhoff, in which the thumb is placed in the palm of the hand and held with the fingers, and the hand is then ulnar deviated (see second image), causing intense pain over the radial styloid which disappears if the thumb is released. This test produces more false positive results than the test described by Finkelstein.[6][7]

Method[edit]

The examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. If there is an increased pain in the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons, then the test is positive for de Quervain’s syndrome.

Special considerations/implications[edit]

Eichhoff's test is commonly mislabeled as being Finkelstein's test.[8] This is significant because Eichhoff's test may create pain in other tissues to come back a false positive or may come back negative though de Quervain’s syndrome is still suspected, the patient can radially deviate against resistance to possibly reproduce pain. If performed correctly by the examiner, Finkelstein's test does not give false positives.

References[edit]

Konin, Jeff G., Denise L. Wiksten, Jerome A. Isear, and Holly Brader. Special Tests for Orthopedic Examination. 3rd ed. Thorofare, NJ: SLACK Incorporated. 2006. 113–114. Print.

Starkey, Chad, Sara D. Brown, and Jefferey L. Ryan. Orthopedic and Athletic Injury Evaluation Handbook. Philadelphia: F.A. Davis. 2010. 524. Print.

  1. ^ a b c Ilyas A, Ast M, Schaffer AA, Thoder J (2007). "De quervain tenosynovitis of the wrist". J Am Acad Orthop Surg. 15 (12): 757–64. PMID 18063716. 
  2. ^ Campbell, William Wesley; DeJong, Russell N. (2005). DeJong's the Neurologic Examination. Lippincott Williams & Wilkins. p. 583. ISBN 9780781727679. 
  3. ^ de Quervain’s Tenosynovitis: Finkelstein’s Test
  4. ^ http://jhs.sagepub.com/content/39/3/286
  5. ^ Finkelstein, H., (1930): Stenosing tenosynovinitis at the radial styloid process. The Journal of Bone and Joint Surgery, 1930, 12: 509-540.
  6. ^ Finkelstein's test at Who Named It?
  7. ^ Ahuja NK, Chung KC (November 2004). "Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process". J Hand Surg [Am]. 29 (6): 1164–70. doi:10.1016/j.jhsa.2004.05.019. PMID 15576233. Retrieved 2009-04-14.  Full text
  8. ^ Elliott, B. G. (1992). "Finkelstein's test: A descriptive error that can produce a false positive". Journal of hand surgery (Edinburgh, Scotland). 17 (4): 481–2. PMID 1402284.