Finkelstein's test is a test used to diagnose de Quervain's tenosynovitis in people who have wrist pain. [1]
Classical descriptions of the Finkelstein's test are when the examiner grasps the thumb and ulnar deviates the hand sharply. [1] If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain's tenosynovitis is likely. [2]
Finkelstein's test is commonly confused with Eichhoff's test: [1] the Eichhoff's test is typically described as the examiner grasping and ulnar deviating the hand when the person has their thumb held within their fist. If sharp pain occurs along the distal radius, Quervain's tenosynovitis is suspected. [3]
Eichhoff's test may produce false positive results, while a Finkelstein's test performed by a skilled practitioner is unlikely to produce a false positive. [4]
Finkelstein's test is one way to determine if there is tenosynovitis in the abductor pollicis longus and extensor pollicis brevis tendons of the wrist. These two tendons belong to the first dorsal compartment.
Finkelstein's test was described by Harry Finkelstein (1865–1939), an American surgeon, in 1930. [5]
A similar test was previously described by Eichhoff, in which the thumb is placed in the palm of the hand and held with the fingers, and the hand is then ulnar deviated (see images), causing intense pain over the radial styloid which disappears if the thumb is released. This test produces more false positive results than the test described by Finkelstein. [6] [7]
The examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. If there is an increased pain in the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons, then the test is positive for de Quervain’s syndrome.
Eichhoff's test is commonly mislabeled as being Finkelstein's test. [8] This is significant because Eichhoff's test may create pain in other tissues to come back a false positive or may come back negative though de Quervain’s syndrome is still suspected, the patient can radially deviate against resistance to possibly reproduce pain. If performed correctly by the examiner, Finkelstein's test does not give false positives.
The carpal bones are the eight small bones that make up the wrist (carpus) that connects the hand to the forearm. The term "carpus" and "carpal" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the carpal bones is to articulate with the radial and ulnar heads to form a highly mobile condyloid joint, to provide attachments for thenar and hypothenar muscles, and to form part of the rigid carpal tunnel which allows the median nerve and tendons of the anterior forearm muscles to be transmitted to the hand and fingers.
The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.
The extensor carpi radialis longus is one of the five main muscles that control movements at the wrist. This muscle is quite long, starting on the lateral side of the humerus, and attaching to the base of the second metacarpal bone.
In human anatomy, extensor carpi radialis brevis is a muscle in the forearm that acts to extend and abduct the wrist. It is shorter and thicker than its namesake extensor carpi radialis longus which can be found above the proximal end of the extensor carpi radialis brevis.
De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On some occasions, there is uneven movement or triggering of the thumb with radial abduction. Symptoms can come on gradually or be noted suddenly.
Intersection syndrome is a painful condition that affects the lateral side of the forearm when inflammation occurs at the intersection of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi radialis longus and the extensor carpi radialis brevis. These 1st and 2nd dorsal muscle compartments intersect at this location, hence the name. The mechanism of injury is usually repetitive resisted extension, as with rowing, weight lifting, or pulling.
Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.
The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is longer than the radius, but the radius is thicker. The radius is a long bone, prism-shaped and slightly curved longitudinally.
The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.
In human anatomy, the extensor pollicis longus muscle (EPL) is a skeletal muscle located dorsally on the forearm. It is much larger than the extensor pollicis brevis, the origin of which it partly covers and acts to stretch the thumb together with this muscle.
In human anatomy, the abductor pollicis longus (APL) is one of the extrinsic muscles of the hand. Its major function is to abduct the thumb at the wrist. Its tendon forms the anterior border of the anatomical snuffbox.
In human anatomy, the extensor pollicis brevis (EPB) is a skeletal muscle on the dorsal side of the forearm. It lies on the medial side of, and is closely connected with, the abductor pollicis longus. The extensor pollicis brevis belongs to the deep group of the posterior fascial compartment of the forearm. It is a part of the lateral border of the anatomical snuffbox.
The radial styloid process is a projection of bone on the lateral surface of the distal radius bone.
The posterior compartment of the forearm contains twelve muscles which primarily extend the wrist and digits. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.
The mobile wad is a group of the following three muscles found in the lateral compartment of the forearm:
The cervical spinal nerve 8 (C8) is a spinal nerve of the cervical segment.
The mucous sheaths of the tendons on the back of the wrist are protective coverings for tendons in the wrist. Between the dorsal carpal ligament and the bones six compartments are formed for the passage of tendons, each compartment having a separate mucous sheath. One is found in each of the following positions:
The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend, or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).
The muscles of the thumb are nine skeletal muscles located in the hand and forearm. The muscles allow for flexion, extension, adduction, abduction and opposition of the thumb. The muscles acting on the thumb can be divided into two groups: The extrinsic hand muscles, with their muscle bellies located in the forearm, and the intrinsic hand muscles, with their muscles bellies located in the hand proper.