The Finkelstein test is a physical maneuver used by healthcare professionals to determine the source of pain on the thumb side of the wrist. It functions as a provocative test, designed to specifically stress a structure to see if it reproduces the patient’s discomfort. This assessment involves a precise movement of the hand and wrist that places tension on the tendons that control thumb movement.
The Condition Diagnosed by the Test
The specific condition the Finkelstein test identifies is De Quervain’s tenosynovitis, which is an inflammation of the protective sheath surrounding tendons. This painful condition affects the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) tendons, which move the thumb and share the narrow first dorsal compartment on the wrist’s thumb side. When the sheaths around these tendons become swollen or thickened, the tendons experience increased friction as they glide through the confined space. This leads to pain and swelling felt predominantly along the radial side of the wrist, near the base of the thumb. The condition is frequently associated with repetitive hand and wrist motions or hormonal fluctuations, such as those experienced during pregnancy.
Step-by-Step Procedure of the Assessment
The procedure begins by requiring the individual to place the thumb across the palm of the hand. Next, the fingers are closed over the thumb to form a fist. The examiner then stabilizes the forearm to isolate the movement to the wrist joint only. The final movement is the gentle bending of the wrist toward the little finger side, known as ulnar deviation. This action maximally stretches the tucked thumb tendons, compressing the inflamed tendons and their swollen sheaths against the radial styloid, which elicits a sharp, localized pain response if irritation is present.
Interpreting Positive and Negative Results
A positive result is indicated by the reproduction of sharp, intense pain precisely over the first dorsal compartment near the radial styloid. This pain confirms inflammation of the abductor pollicis longus and extensor pollicis brevis tendons or their surrounding sheaths. The location of the pain helps the clinician differentiate De Quervain’s tenosynovitis from other causes of wrist pain, such as arthritis in the thumb joint. Conversely, a negative result is recorded if the individual experiences no pain or only a mild stretch sensation during the maneuver. While a positive test is strong evidence, it is not considered definitive proof of the diagnosis on its own, and a healthcare professional uses the results in conjunction with the patient’s medical history and overall clinical presentation.