Finkelstein’s Test

Finkelstein’s Test is used to diagnose De Quervain’s syndrome, a condition characterized by tenosynovitis of the tendons extensor pollicis brevis (EPB) and abductor pollicis longus (APL). The condition arises from irritation and inflammation of the tendon sheath at the base of the thumb, making thumb and wrist movements painful【1】.

Named after Fritz de Quervain, the Swiss surgeon who first described the syndrome, this test remains one of the most important clinical maneuvers to evaluate radial-sided wrist pain.

Anatomical Basis

The two tendons involved pass through the first dorsal extensor compartment at the wrist:

• Extensor pollicis brevis (EPB): inserts into the proximal phalanx and extensor apparatus of the thumb.

• Abductor pollicis longus (APL): inserts onto the radial-dorsal side of the first metacarpal【2】.

Inflammation of their shared synovial sheath leads to swelling, thickening, and pain, particularly during thumb and wrist movements.

Test Procedure

Patient Position

• Patient seated or standing, with the hand relaxed.

Execution

1. The patient flexes the thumb maximally and wraps the fingers around it, forming a fist.

2. The patient then ulnarly deviates the wrist, stretching the tendons in the first extensor compartment.

3. Modified version: The examiner assists by passively ulnar-deviating the wrist while drawing the thumb into the palm. This often provokes stronger pain【3】【4】.

Interpretation

• Negative test: No pain along the tendons.

• Positive test: Pain at the first extensor compartment, often radiating proximally along the radial forearm, suggests De Quervain’s syndrome【3】【5】.

Diagnostic Value

• The test works by elongating and stressing the EPB and APL tendons, provoking pain in inflamed tendon sheaths【6】.

• Evidence on validity is limited, but studies report high clinical reliability【7】.

• Should be combined with:

  • Palpation of the first dorsal compartment

  • Eichhoff’s test (a related maneuver)

  • Differential testing for radial nerve entrapment and arthritis of the carpometacarpal joint.

Conclusion

Finkelstein’s Test is a fast, simple, and highly specific clinical maneuver for identifying De Quervain’s syndrome. A positive result—sharp pain over the first dorsal compartment—strongly supports the diagnosis. However, it should always be interpreted in combination with other clinical findings and imaging when necessary.

Sources

1.  Extensor pollicis brevis muscle (highlighted in green) - posterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/extensor-pollicis-brevis-muscle

2. Abductor pollicis longus muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/abductor-pollicis-longus-muscle

3. Richard Day, John Fox; Neuro- musculoskeletal clinical tests; Churchill Livingstone Elsevier 2009- page 113 (Level of evidence = E)

4. Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic sports physical therapy: volume 40,number 6, June 2010. (level of evidence = C)

5. How to Perform a Finkelstein's Test of the Hand (level of evidence = E)

6. Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 303.

7. Javier González-Iglesias, Peter Huijbregts, César Fernández-de-las-Peñas, Joshua A. Cleland; Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months’ Duration: A Case Report; journal of orthopaedic; sports physical therapy: volume 40, number 6, June 2010.(level of evidence = C)