Revisiting an Old Friend: The Finkelstein Test
Turn your hand thumb up toward the ceiling. Place your thumb inside your palm and close your fingers around it. Now bend the wrist down toward the floor. This test is called the Finkelstein test. If you have severe wrist pain with this test, you may have a condition called de Quervain's tendonitis (also referred to as de Quervain's tenosynovitis).

But you could also have arthritis of the joint at the base of the thumb, wrist arthritis, or another condition called intersection syndrome. As the authors of this study show, the Finkelstein test (as it was just described to you) can identify a wrist problem on the radial (thumb) side. But it doesn't necessarily prove the patient has de Quervain's. They propose an alternate way to perform the test that is more reliable and less painful for the patient.

De Quervain's tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole.

This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis.

Three changes occur in the tendons (as observed during surgery for this problem): thickening of the tendon sheath, enlargement of the tendons, and thickening of tenosynovium. In de Quervain's tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel.

The Finkelstein test has been described and taught to trainees (orthopedic surgeons, physical therapists, occupational therapists, athletic trainers) several different ways. The most common is the one you tried on yourself. But the test can be very painful and isn't as specific as needed for an accurate diagnosis.

Over the past 10 years, the authors of this article have tested a staged test maneuver to diagnose de Quervain's. They report the staged test is easier on the patient and a reliable diagnostic test. The test is done like so: place your hand on the edge of a table (or arm rest on a chair) with the wrist supported but the hand off the edge of the supporting surface. Now tilt your hand down toward the floor.

When someone else is examining you, that examiner will then gently grasp your hand and passively (without your help) move the wrist a little farther in the downward direction. The final step is for the examiner to press down on your thumb (moving it toward your palm). Neither one of these last two steps is performed if you (or the patient) has pain with the first step.

The staged Finkelstein test as described here causes a stretch to the inflamed tendons. As the affected tendons are forced to move through the constricted area and over the bone underneath, pain is produced. The authors advocate stopping the test at the first point of pain. Placing additional traction on the wrist and/or thumb isn't necessary. There's no need to cause the person severe, intense pain if the test is positive on the first step.

Pictures of the test along with descriptions are provided to give surgeons a better understanding of this staged version of the Finkelstein test. The authors hope to spread the word to all who are learning this test so that it is performed the same way by everyone. Consistency in using this approach will aid in carrying out research that can be compared from one study to another with the added benefit of reducing discomfort to the patient.
Courtney Dawson, MD, and Chaitanya S. Mudgal, MD. Staged Description of the Finkelstein Test. In The Journal of Hand Surgery. September 2010. Vol. 35A. No. 9. Pp. 1513-1515.