Hand Surgery Source

Finkelstein Sign

Test, Exam and Signs

Historical Overview

  • Finkelstein’s test was first described by H Finkelstein in 1930.1

Description

  • Finkelstein’s test involves passive flexion of the wrist in ulnar deviation, with the thumb held fixed in the palm by the other fingers.1
  • This exam manuever used to demonstrate tenosynovitis in the first extensor tendon compartment on the radial aspect of the wrist.

Pathophysiology

  • De Quervain’s disease or tenosynovitis of the abductor pollicis longus tendon.1

Instructions

  1. Ask the patient to place their thumb inside their closed fist.2
  2. Passively deviate the wrist in the ulnar direction.2

Variations

  • Another method is to passively adduct the patient’s thumb.2

Related Signs and Tests

  • Eichhoff’s test3
  • Brunelli test3
  • Wrist hyperflexion and abduction of the thumb (WHAT) test4

Diagnostic Performance Characteristics

  • This test is not used as “stand-alone” test in clinical practice. Therefore, its diagnostic performance characteristics have not warranted significant investigation.
  • A positive test result, in conjunction with symptomatic swelling at the level of the radial styloid and tenderness just proximal to the tip of the radial styloid are used to diagnose De Quervain’s disease.1
Presentation Photos and Related Diagrams
  • Traditional Finkelstein Sign
    Traditional Finkelstein Sign
  • Finkelstein Sign with passive stretching of the EPB only
    Finkelstein Sign with passive stretching of the EPB only
Definition of Positive Result
  • A positive test result is when the patient feels a sharp pain that reproduces the pateint's symptoms at the first extensor compartment at the radial styloid area of the wrist.1
Definition of Negative Result
  • A negative test result occurs when a patient does not feel a sharp pain at the first extensor compartment at the radial styloid area of the wrist.1
Comments and Pearls
  • Pain over the radial styloid from this provocative stretch maneuver differentiates de Quervain’s tenosynovitis from arthritis of the first metacarpal,5 only if you do the Finckelstien sign manuever correctly. You can not simply ask the patient if it hurts when the test is done. The examiner should keep his/her thumb or finger on the first extensor compartment will doing the Finckelstein Test and ask the patietn to report pain(tenderness) only if it occurs under the exmaniner's finger at the radial styloid.  If Finckelstein test manuever also puts  pressure on the thumb CMC joint and if the examiner is not specific the patient will report pain but it will be from the arthritic thumb cmc joint and not from the pinched tendon in the first extensor compartment.
Diagnoses Associated with Tests, Exams and Signs
Video
DeQuervain's Exam
YouTube Videos
DeQuervain's Tenosynovitis (Radial Styloid Tenosynovitis)
References
  1. Tubiana R, Thomine, J-M. Mackin E. Examination of the Hand and Wrist. New York: Informa Healthcare, 2009.
  2. Rayan GM and Akelman, E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  3. Frontera W, Silver J, Rizzo T. Essentials of Physical Medicine and Rehabilitation, 2nd Edition. Philadelphia: Saunders Elsevier, 2008
  4. Goubau JF, et al. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff's Test. J Hand Surg Eur 2014;39:286-92. PMID: 23340762
  5. Forman T, Forman S, Rose N. A clinical approach to diagnosing wrist pain. Am Fam Physician 2005;72(9):1753-6. PMID 16300037