The Finkelstein Test is a non-invasive physical examination maneuver used by clinicians to diagnose a common source of wrist and thumb pain. This assessment, first described by American surgeon Harry Finkelstein in 1930, helps determine if symptoms are caused by a specific inflammatory condition. The test works by placing tension on certain tendons in the wrist to provoke pain. It is a highly specific method used to differentiate this particular tendon issue from other causes of pain on the thumb side of the wrist.
The Condition It Identifies
The Finkelstein Test is designed to pinpoint the presence of De Quervain’s Tenosynovitis (DQT). This painful condition affects the Abductor Pollicis Longus and the Extensor Pollicis Brevis tendons, which run through a small, fibrous tunnel called the first dorsal compartment on the thumb side of the wrist. In DQT, the protective sheath surrounding these tendons becomes irritated, leading to thickening and swelling. This swelling constricts the limited space, making it difficult for the tendons to glide smoothly when the thumb is moved.
The friction and restriction cause localized pain near the base of the thumb and the wrist. Patients often report difficulty with movements like grasping, pinching, or making a fist, and may notice a “sticking” or “snapping” sensation. DQT is frequently linked to chronic overuse or repetitive hand and wrist motions. It also has a high incidence in new parents, sometimes known as “Mommy Thumb,” due to the repeated lifting of an infant. Hormonal changes during pregnancy are another contributing factor.
Performing the Test Maneuver
The physical assessment is a specific, two-part action that mechanically stresses the two tendons involved in DQT. To begin, the patient bends their thumb across the palm of their hand. They then fully wrap their remaining four fingers over the thumb, making a tight fist with the thumb tucked inside. This initial step places the tendons in a position of relative tension.
The second and more provocative part of the test is the ulnar deviation of the wrist. With the fist held firmly, the clinician or the patient gently bends the wrist downward toward the little finger side of the hand. This movement sharply stretches the already-compressed tendons and their inflamed sheath. If DQT is present, performing this maneuver causes a sudden, intense flare of pain, so the test is often best performed under the guidance of a trained healthcare provider.
Interpreting the Outcome
The result of the Finkelstein Test is determined by the patient’s pain response during the ulnar deviation phase. A “positive” result is indicated by the reproduction of sharp, localized pain along the radial side of the wrist, near the base of the thumb. This sudden, acute pain confirms that the two tendons in the first dorsal compartment are being painfully compressed and stretched, strongly suggesting a diagnosis of DQT.
A “negative” result is recorded if the patient experiences no significant pain or only a mild stretch sensation. Following a positive test, the diagnosis is often confirmed clinically. Initial management focuses on conservative strategies to reduce inflammation, including activity modification, wearing a thumb spica splint, and using non-steroidal anti-inflammatory medications. In persistent cases, a corticosteroid injection directly into the tendon sheath may be administered.