Finkelstein Test

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Original Editor - Tracy Hall

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Purpose

add the purpose of this assessment technique here
To test for the presence of tenosynovitis of the abductor pollicic longus and extensor pollicis brevis tendons in the dorsal tunnel of the wrist.Finkelstein maneuver is a helpful test to diagnose deQuervain’s Tendonitis or first dorsal compartment tendonitis named after the Swiss surgeon Fritz de Quervain This is a condition brought on by irritation or inflammation of the wrist tendons at the base of the thumb . The inflammation causes the compartment (a tunnel or a sheath) around the tendon to swell and enlarge, making thumb and wrist movement painful.

Technique

The Finkelstein test draws the tendons of the first dorsal compartment distally and causes sharp, local pain when tendon entrapment has occurred and inflammation is present. The patient is standing or seated and is instructed to make a fist with the thumb between the palm and the fingers. The examiner then stabilizes the forearm with the one hand and passively ulnerly deviates the wrist.Ask the patient if he or she feels pain radiating up the inside of his or her arm from the thumb. If the patient reports noticeable pain, the Finkelstein's Test is positive, and De Quervain syndrome is present.

The Journal of hand surgery ISSN 0363-5023 CODEN JHSUDV 2005, vol. 30A, no1, pp. 130-135 [6 page(s) (article)] (8 ref.)

Finkelstein's test is the classic diagnostic test for de Quervain's disease. Finkelstein hypothesized that the entry of the muscle bellies of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons into the first extensor compartment was responsible for the findings observed in his now eponymous test. We agree Finkelstein's hypothesis and further hypothesize that this position would induce measurable bulk (mucle mass within the retinaculum) and tethering (stretching of synovial tissue) effects within the compartment. To test this latter hypothesis we measured the excursion and gliding resistance of the EPB and APL tendons within the first compartment. Methods: Fifteen fresh-frozen cadavers were used. Gliding resistance and excursion were measured in 4 different wrist positions, including the wrist position of Finkelstein's test (30° ulnar deviation). The bulk and tethering effect was calculated based on the mean gliding resistance over the tendon proximal/distal excursion cycle and the gliding resistance at the terminal distal excursion. Results: The EPB tendon excursion was signficantly more distal in 30° ulnar deviation than in 60° extension. Additionally the bulk and tethering resistance was significantly greater in 30° ulnar deviation compared with 60° extension. For the APL tendon there was no significant difference in either the tendon excursion or the bulk and tethering resistance between 30° ulnar deviation and 60° extension. Conclusions: We showed that in the position of Finkelstein's test the EPB tendon is significantly more distal and has significantly greater bulk and tethering effect compared with the other EPB positions. This is not the case for the API. tendon in the position of Finkelstein's test. These results suggest that an abnormal Finkelstein's test reflects differences of the EPB more than it does the APL. ==

Recent Related Research (from Pubmed)

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References

www.Emedicine.medscape.medscape.com/article/1243387 www.assh.org/Public/HandConditions/Pages/deQuervain'sTendonitis.aspx

The Journal of hand surgery ISSN 0363-5023 CODEN JHSUDV
2005, vol. 30A, no1, pp. 130-135 [6 page(s) (article)] (8 ref.)
 www.med.und.nodak.edu/users/jwhiting/finkel.html

Flynn TW, Clevland JA, Whitman JM, User's Guide To The Musculoskeletal Examination;2008 evidence in motion