Finkelstein Test: Difference between revisions

No edit summary
No edit summary
 
(38 intermediate revisions by 13 users not shown)
Line 1: Line 1:
<div class="editorbox">
<div class="editorbox">
'''Original Editor '''- [[User:Tracy Hall|Tracy Hall]]<br>
'''Original Editor ''' - [[User:Tracy Hall|Tracy Hall]]


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}&nbsp; &nbsp;
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
</div>  
</div>  
== Introduction  ==
== Introduction  ==


<br>  
Finkelstein’s test is the classic provocative test for diagnosis of 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.<br>
 
== Clinically Relevant Anatomy  ==
[[File:Extensor pollicis brevis muscle - Kenhub.png|alt=Extensor pollicis brevis muscle (highlighted in green) - posterior view|right|frameless|500x500px|Extensor pollicis brevis muscle (highlighted in green) - posterior view]]
'''Extensor Pollicis Brevis (EPB)'''
*Radial abduction of wrist (0-25°)
*Thumb extension (90°)
 
 
Image: Extensor pollicis brevis muscle (highlighted in green) - posterior view<ref >Extensor pollicis brevis muscle (highlighted in green) - posterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/extensor-pollicis-brevis-muscle</ref><br>


== Clinically Relevant Anatomy [http://www.handenteam.nl/pdf/Quervain <ref>Morbus de De Quervain;  tendinitis van twee strekkers  van de duim (EPB en APL) in  het eerste extensor compartiment fckLR(Level of evidence = E)</ref>],&nbsp;[http://www.eatonhand.com/mus/mus023.htm <ref>The electronic textbook of hand surgery fckLR(Level of evidence = E)</ref>]&nbsp;  ==
'''Abductor Pollicis Longus (APL)'''
*Wrist radial abduction (0- 25°)  
*Thumb abduction (70°- 80°)
<br>


<u>'''[http://www.eatonhand.com/mus/mus023.htm M. extensor pollicis brevis (EPB)]'''</u> <br> Function: -wrist joint: radial abduction (0-25°) <br>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; thumb: extension (90°)
This 2 minute video is a good summary of the abductor pollicis longus.<ref >Abductor pollicis longus muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/abductor-pollicis-longus-muscle</ref>
{{#ev:youtube|Hoc7Hc_6u0A}}


<br><u>'''[http://www.eatonhand.com/mus/mus004.htm M. abductor pollicis longus (APL)]'''</u>'''&nbsp;[http://www.dartmouth.edu/~humananatomy/figures/chapter_10/10-3.HTM <ref>BASIC HUMAN ANATOMY - O'RAHILLY, MÜLLER, CARPENTER &amp;amp;amp;amp; SWENSON (Level of evidence = E)</ref>]'''<br> Function: - wrist joint: radial abduction (0- 25°) <br>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; - thumb: abduction (70°- 80°) <br>
== Purpose of Testing  ==


== Purpose of Testing<br>  ==
The Finkelstein test is used in the diagnosis of [[De Quervain's Tenosynovitis|De Quervain's]] syndrome. This fact implies a tenovaginitis and tenosynovitis of the M. extensor pollicis brevis and M. abductor pollicis longus. Finkelstein maneuver is a helpful test to diagnose De Quervain'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.


The Finkelstein test is used in the diagnosis of [http://www.physio-pedia.com/index.php5?title=De_Quervains De Quervain's] syndrome. <ref>De Quervain (Level of evidence E)</ref> This fact implies a tenovaginitis and tenosynovitis of the M. extensor pollicis brevis and M. abductor pollicis longus.[http://www.handenteam.nl/pdf/Quervain <ref>Morbus de De Quervain;  tendinitis van twee strekkers  van de duim (EPB en APL) in  het eerste extensor compartiment fckLR(Level of evidence =E)</ref>] &nbsp;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.
== Testing Position ==
<div class="createbox" align="center"><br></div>
== Testing Position ==


Sitting or standing.  
Sitting or standing.  


== Technique&nbsp; ==
== Technique  ==
 
To begin, the patient must sit comfortable and relaxed on the examination table. Next, examine the patients hand in the air, while the other hand rests just beside the body. The therapist then asks the patient to make a fist around a thumb and to perform a ulnar deviation. <ref>Morbus de De Quervain;  tendinitis van twee strekkers  van de duim (EPB en APL) in  het eerste extensor compartiment fckLR(Level of evidence = E)</ref>, [http://emedicine.medscape.com/article/327453-overview <ref>Patrick M Foye, MD; Chief Editor: Rene Cailliet, MD; Physical Medicine and Rehabilitation for De Quervain Tenosynovitis fckLR(Level of evidence = E )</ref>]<br>


A modified version of the test is that the patient must sit comfortable and relaxed on the examination table. The patient must hold his afflicted hand in the air, while the other hand should be resting against his/ her body. The therapist grasps the afflicted hand of the patient and rotates it in ulnar deviation. He pulls the patient’s thumb across the palm of his/ her hand. This causes additional stress on the extensor tendons of the thumb. <ref>Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- pag 113 (Level of evidence = E)</ref>, <ref>Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic sports physical therapy: volume 40,number 6, june 2010.      (level of evidence = C)</ref><br>
To begin, the patient must sit comfortable and relaxed on the examination table. Next, examine the patients hand in the air, while the other hand rests just beside the body. The therapist then asks the patient to make a fist around a thumb and to perform a ulnar deviation.


<br>  
A modified version of the test is that the patient must sit comfortable and relaxed on the examination table. The patient must hold his afflicted hand in the air, while the other hand should be resting against his/ her body. The therapist grasps the afflicted hand of the patient and rotates it in ulnar deviation. He pulls the patient’s thumb across the palm of his/ her hand. This causes additional stress on the extensor tendons of the thumb. <ref name="Day">Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- page 113 (Level of evidence = E)</ref><ref>Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic sports physical therapy: volume 40,number 6, June 2010.      (level of evidence = C)</ref>  


The patient actively (or active assistive) flexes thumb maximally and wraps fingers over thumb, making a fist. The patient then ulnarly deviates his/her wrist to stretch the muscles of the 1st extensor compartment. The test is positive if the patient complains of pain over the 1st extensor compartment of the wrist.  
The patient actively (or active assistive) flexes thumb maximally and wraps fingers over thumb, making a fist. The patient then ulnarly deviates his/her wrist to stretch the muscles of the 1st extensor compartment. The test is positive if the patient complains of pain over the 1st extensor compartment of the wrist.  


<br>  
<clinicallyrelevant id="84104022" title="Finkelstein Test" />


&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; {{#ev:youtube|eL2Uzfd26SA}}
== Interpretation  ==


*<u>Negative result</u>: The patient doesn’t feel any pain radiating up the inside of his/ her arm from the thumb. <ref>Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- pag 113 (level of evidence = E)</ref>  
*<u>Negative result</u>: The patient doesn’t feel any pain radiating up the inside of his/ her arm from the thumb. <ref name="Day" />  
*<u>Positive result</u>: 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 then, the Finkelstein's test is positive, what indicates De Quervains syndrome. <ref>Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- pag 113 (level of evidence = E)</ref>, [http://www.ehow.com/how_2212413_perform-finkelsteins-test-hand.html <ref>How to Perform a Finkelstein's Test of the Hand  (level of evidence = E)</ref>]
*<u>Positive result</u>: 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 then, the Finkelstein's test is positive, what indicates De Quervain's syndrome. <ref name="Day" />[http://www.ehow.com/how_2212413_perform-finkelsteins-test-hand.html <ref>How to Perform a Finkelstein's Test of the Hand  (level of evidence = E)</ref>][[Finkelstein Test#cite%20note-3|<span class="mw-reflink-text">[3]</span>]][[Finkelstein Test|<span class="mw-reflink-text">[3]</span>]][[Finkelstein Test|<span class="mw-reflink-text">[3]</span>]]<span class="mw-reflink-text">[4]</span>


== Importance of Test  ==
== Importance of Test  ==


The muscles that cross the wrist are separated into compartments by the extensor retinaculum. In the first compartment, the tendons of the extensor pollicis brevis and abductor pollicis longus pass through to attach distally. According to Neumann, the extensor pollicis brevis attaches distally to the dorsal side of the proximal phalanx and extensor mechanism of the thumb, while the abductor pollicis longus attaches distally to the radial-dorsal side of the 1st metacarpal. The combination of maximum finger flexion and wrist ulnar deviation elongates these tendons and produces pain in symptomatic individuals.<ref>Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 303.</ref>  
The muscles that cross the wrist are separated into compartments by the extensor retinaculum. In the first compartment, the tendons of the extensor pollicis brevis and abductor pollicis longus pass through to attach distally. According to Neumann, the extensor pollicis brevis attaches distally to the dorsal side of the proximal phalanx and extensor mechanism of the thumb, while the abductor pollicis longus attaches distally to the radial-dorsal side of the 1st metacarpal. The combination of maximum finger flexion and wrist ulnar deviation elongates these tendons and produces pain in symptomatic individuals.<ref>Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 303.</ref><br>  
 
== <u>Realibility</u><u><br></u>  ==
 
*Investigation into the validity of tests are important to know whether our tests are reliable or not. Studies that test the reliability of the Finkelstein test are very limited. One research shows that the Finkelstein test has a high reliability <ref>Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic; sports physical therapy: volume 40,number 6, june 2010.(level of evidence = C)</ref>, but further research is still required. To prove or to refute the reliability of the Finkelstein test further research is required. <br>
 
<br>
 
<br>
 
== The Journal of hand surgery ISSN 0363-5023 CODEN JHSUDV&nbsp;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
 
== Key Research  ==
 
*Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report.<br>
 
<br>  
 
== Resources  ==


Pubmed and ISI Web of Knowledge, Internet.
== Reliability  ==


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
*Investigation into the validity of tests are important to know whether our tests are reliable or not.<br>  
<div class="researchbox">
*Studies that test the reliability of the Finkelstein test are very limited. One research shows that the Finkelstein test has a high reliability <ref>Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic; sports physical therapy: volume 40, number 6, June 2010.(level of evidence = C)</ref>, but further research is still required.<br>
• [http://www.ncbi.nlm.nih.gov/pubmed/19588376 Corticosteroid injection for de Quervain's tenosynovitis]<br>• Long-term results of surgical release of de Quervain’s stenosing tenosynovitis<br>• [http://www.ncbi.nlm.nih.gov/pubmed/17059194 De Quervain's stenosing tendovaginitis one of the most common conditions affecting the hand]<br>• [http://www.ncbi.nlm.nih.gov/pubmed/16817306 Finkelstein's test]<br>
</div>  
== References<br> ==


<references />


[http://www.Emedicine.medscape.medscape.com/article/1243387 www.Emedicine.medscape.medscape.com/article/1243387] www.assh.org/Public/HandConditions/Pages/deQuervain'sTendonitis.aspx
== References  ==


The Journal of hand surgery ISSN 0363-5023 CODEN JHSUDV <br>2005, vol. 30A, no1, pp. 130-135 [6 page(s) (article)] (8 ref.)<br>&nbsp;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&lt;/div&gt;
<references />


[[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Hand]] [[Category:Special_Tests]] [[Category:Wrist]]
[[Category:Assessment]]  
[[Category:Wrist - Assessment and Examination]]
[[Category:Hand - Assessment and Examination]]
[[Category:Special Tests]]
[[Category:Wrist]]
[[Category:Hand]]
[[Category:Tendons]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:EIM_Residency_Project]]
[[Category:Primary Contact]]
[[Category:Sports Medicine]]
[[Category:Sports Injuries]]
[[Category:Athlete Assessment]]
[[Category:Wrist - Special Tests]]
[[Category:Hand - Special Tests]]

Latest revision as of 04:33, 31 March 2022

Original Editor - Tracy Hall

Top Contributors - Aurelie Canas Perez, Admin, Kim Jackson, Venus Pagare, Rachael Lowe, Tracy Hall, Evan Thomas, Kai A. Sigel, Joao Costa, Tarina van der Stockt, WikiSysop, Laura Ritchie, Claire Knott, Wanda van Niekerk, Jennifer Chew and Tony Lowe

Introduction[edit | edit source]

Finkelstein’s test is the classic provocative test for diagnosis of 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.

Clinically Relevant Anatomy[edit | edit source]

Extensor pollicis brevis muscle (highlighted in green) - posterior view

Extensor Pollicis Brevis (EPB)

  • Radial abduction of wrist (0-25°)
  • Thumb extension (90°)


Image: Extensor pollicis brevis muscle (highlighted in green) - posterior view[1]

Abductor Pollicis Longus (APL)

  • Wrist radial abduction (0- 25°)
  • Thumb abduction (70°- 80°)


This 2 minute video is a good summary of the abductor pollicis longus.[2]

Purpose of Testing[edit | edit source]

The Finkelstein test is used in the diagnosis of De Quervain's syndrome. This fact implies a tenovaginitis and tenosynovitis of the M. extensor pollicis brevis and M. abductor pollicis longus. Finkelstein maneuver is a helpful test to diagnose De Quervain'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.

Testing Position[edit | edit source]

Sitting or standing.

Technique[edit | edit source]

To begin, the patient must sit comfortable and relaxed on the examination table. Next, examine the patients hand in the air, while the other hand rests just beside the body. The therapist then asks the patient to make a fist around a thumb and to perform a ulnar deviation.

A modified version of the test is that the patient must sit comfortable and relaxed on the examination table. The patient must hold his afflicted hand in the air, while the other hand should be resting against his/ her body. The therapist grasps the afflicted hand of the patient and rotates it in ulnar deviation. He pulls the patient’s thumb across the palm of his/ her hand. This causes additional stress on the extensor tendons of the thumb. [3][4]

The patient actively (or active assistive) flexes thumb maximally and wraps fingers over thumb, making a fist. The patient then ulnarly deviates his/her wrist to stretch the muscles of the 1st extensor compartment. The test is positive if the patient complains of pain over the 1st extensor compartment of the wrist.

Finkelstein Test video provided by Clinically Relevant

Interpretation[edit | edit source]

  • Negative result: The patient doesn’t feel any pain radiating up the inside of his/ her arm from the thumb. [3]
  • Positive result: 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 then, the Finkelstein's test is positive, what indicates De Quervain's syndrome. [3][5][3][3][3][4]

Importance of Test[edit | edit source]

The muscles that cross the wrist are separated into compartments by the extensor retinaculum. In the first compartment, the tendons of the extensor pollicis brevis and abductor pollicis longus pass through to attach distally. According to Neumann, the extensor pollicis brevis attaches distally to the dorsal side of the proximal phalanx and extensor mechanism of the thumb, while the abductor pollicis longus attaches distally to the radial-dorsal side of the 1st metacarpal. The combination of maximum finger flexion and wrist ulnar deviation elongates these tendons and produces pain in symptomatic individuals.[6]

Reliability[edit | edit source]

  • Investigation into the validity of tests are important to know whether our tests are reliable or not.
  • Studies that test the reliability of the Finkelstein test are very limited. One research shows that the Finkelstein test has a high reliability [7], but further research is still required.


References[edit | edit source]

  1. ↑ Extensor pollicis brevis muscle (highlighted in green) - posterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/extensor-pollicis-brevis-muscle
  2. ↑ Abductor pollicis longus muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/abductor-pollicis-longus-muscle
  3. ↑ 3.0 3.1 3.2 Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- page 113 (Level of evidence = E)
  4. ↑ Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic sports physical therapy: volume 40,number 6, June 2010. (level of evidence = C)
  5. ↑ How to Perform a Finkelstein's Test of the Hand (level of evidence = E)
  6. ↑ Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 303.
  7. ↑ Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic; sports physical therapy: volume 40, number 6, June 2010.(level of evidence = C)
Retrieved from "https://www.physio-pedia.com/index.php?title=Finkelstein_Test&oldid=299332"