Finkelstein’s Test: Do We Do It The Same and Who Is Doing It Correctly?,
Clinical Pearl No. 8 – February 2010

HandLab Clinical Pearls

Feburary 2010                                No. 8

 FINKELSTEIN’S TEST: DO WE DO IT THE SAME AND WHO IS DOING IT CORRECTLY?

 

The diagnosis of de Quervain’s tenosynovitis is commonly decided as a result of a painful response to Finkelstein’s test.

Many clinicians currently define Finkelstein’s test as passive ulnar deviation of the wrist while the thumb is clasped in the palm by the fingers. (Figure 1). I would suggest that many of us without symptoms would have a painful response to this maneuver as it places the maximum tension on the tendons in the first dorsal compartment. Unfortunately, this testing position can create a false positive test.

Finkelstein’s original description in 1939 instructed the examiner to grasp the patient’s thumb and quickly deviate the wrist ulnarward (Figure 2).No 8-FEB2010

Figure 1: Current commonly described testing position.

A positive test is the patient’s report of pain over the radial styloid. Finkelstein states: “This is probably the most pathognomic objective sign.”2

Elliot, in an article in the British Journal of Hand Surgery in 1992, points out the problem of the common incorrect testing maneuver.1 This topic would be a useful point of discussion among therapists and surgeons working together to assure consistency in evaluation of this common problem.

No 8-FEB2010-1

Figure 2: Testing position as originally described by Finkelstein.

References
1. Elliot, BG: Finkelstein’s test: a descriptive error that can produce a false positive. Jour Hand Surg 17B:4, 1992: 481-82.
2. Finkelstein, H: Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg 12, 1939: 509-40.

Download Clinical Pearl No. 8, Finkelstein’s Test: Do We Do It The Same and Who Is Doing It Correctly?, February 2010

 

ADDITIONAL SUGGESTED READING

Clinical Pearl No. 29 – The Hoffman-Tinel Sign

Clinical Pearl No. 25 – Froment’s Sign & Jeanne’s Sign in Ulnar Palsy

Clinical Pearl No. 8 – Finkelstein’s Test: Do We Do It the Same and Who Is Doing it Correctly?

Clinical Pearl No. 6 – Technique for Recording Semmes Weinstein Monofilament Response

Book Chapter – Obstetrical Brachial Palsy: The Hand Therapist’s Role, Tendon and Nerve Surgery in the Hand: A Third Decade – 1997

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Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.