Finkelstein's test

Overview
Finkelstein's test, also known as the Finkelstein maneuver, is a clinical examination technique employed primarily to assess for de Quervain's tenosynovitis—a painful inflammatory condition of the first dorsal compartment of the wrist that contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. The test may also be referenced in the context of scaphoid fractures, though that application is less common and typically described as a "Finkelstein sign."

Procedure

1. The patient is instructed to make a fist with the thumb tucked inside the fingers.
2. The examiner then gently ulnar‑deviates (bends toward the little finger) the wrist while the hand remains pronated.
3. The maneuver is performed smoothly to avoid excessive force.

Interpretation

• Positive result: Reproduction of sharp pain over the radial styloid and the first dorsal compartment during ulnar deviation, suggesting inflammation of the APL and EPB tendons consistent with de Quervain's tenosynovitis.
• Negative result: Absence of pain indicates that de Quervain's tenosynovitis is less likely, though other diagnostic considerations may remain.

Diagnostic Utility
Clinical studies have reported variable sensitivity (approximately 70–80 %) and specificity (approximately 60–80 %) for Finkelstein's test in diagnosing de Quervain's tenosynovitis. The test is valued for its simplicity, low cost, and immediate bedside applicability, but it is typically used in conjunction with patient history and other examinations (e.g., the “hitchhiker’s sign” or ultrasound imaging) to confirm the diagnosis.

Differential Considerations

• Scaphoid fracture: Pain elicited by a similar maneuver—often termed the “Finkelstein sign”—may indicate a scaphoid fracture when the patient flexes the wrist and places the thumb inside a clenched fist. However, this is distinct from the classic de Quervain's test described above.
• Other wrist pathologies: Conditions such as intersection syndrome, rheumatoid arthritis, or osteoarthritis of the radiocarpal joint can also cause pain on ulnar deviation, necessitating a broader clinical assessment.

Historical Note
The maneuver is named after Dr. Harry Finkelstein, an American orthopedic surgeon who described the test in the mid‑20th century as a means to differentiate tendon sheath inflammation from other wrist disorders.

Clinical Relevance
Finkelstein's test remains a standard component of musculoskeletal examinations in primary care, sports medicine, orthopedics, and hand surgery practices. Its ease of performance and immediate feedback make it a valuable screening tool for patients presenting with radial‑side wrist pain exacerbated by thumb movement.