Overview of Finkelstein Sign
Harry Finkelstein, an American surgeon who lived from 1865 to 1939, created what is known as the Finkelstein’s test or Finkelstein’s sign back in 1930. This test is a simple method to diagnose a condition known as De Quervain’s disease. The test can easily be done in a doctor’s office or at a patient’s bedside.
The Finkelstein’s test is done by flexing your thumb into your palm and bending your wrist in the direction of your pinky. If the test is positive, you’ll feel a strong tenderness or even pain on the thumb side of your wrist. This indicates that you might have De Quervain’s disease.
De Quervain’s disease is typically seen in people who do a lot of repetitive actions that put stress on their wrist. For example, people who work as restaurant servers often experience this. Interestingly, it has been observed that De Quervain’s disease is more common in females.
Anatomy and Physiology of Finkelstein Sign
The wrist contains a protective covering called a tendon sheath that hosts the Abductor Pollicis Longus (APL) and the Extensor Pollicis Brevis (EPB) tendons. These tendons are found near the edge of a small, hollow area on the back of the thumb called the anatomical snuffbox. They have unique functions:
– Extensor Pollicis Brevis (EPB) helps in pulling the wrist to the thumb side (0 to 25 degrees) and straightening the thumb (90 degrees).
– Abductor Pollicis Longus (APL) also aids in pulling the wrist to the thumb side (0 to 25 degrees) and moving the thumb away from the rest of the fingers (70 to 80 degrees).
A condition called de Quervain tendinopathy affects both the APL and EPB tendons where they pass through a tunnel from the forearm into the hand. In this disease, the tendons that move the thumb away from the flat hand become enlarged due to thickening, causing swelling and pain in the thumb and wrist during movement. It occurs around 0.94 times per 1000 people per year.
The exact causes of de Quervain tendinopathy are not well-known. It was thought to be associated with repetitive tasks that keep the thumb extended and pulled away from the other fingers. Women are found to be four times more likely to get this than men, and it is increasingly observed in people above 40 and non-white individuals. One theory is that new mothers are prone to this after childbirth due to the repeated hand motions required to hold and lift newborns. Possible causes could also be hormonal changes and fluid retention. However, the supporting data is limited and these are mostly based on observations. In more severe cases where surgery is required, it’s seen that there isn’t an inflammation, but a disorder called myxoid degeneration where collagen gets disorganized and increases cellular structure.
Why do People Need Finkelstein Sign
When someone comes in with wrist pain, particularly on the thumb side of their wrist, doctors might use a method called the Finkelstein test. This simple test helps them figure out if the cause is something called De Quervain’s tenosynovitis. This condition, named after the Swiss surgeon Fritz de Quervain, happens when the tendons on the thumb side of your wrist become inflamed.
Signs that you might have De Quervain’s tenosynovitis include pain in your wrist when you’re pinching something between your thumb and index finger or moving your thumb and wrist. The pain might even spread to your thumb or along the inside of your wrist. Some people also notice their wrist becoming swollen or tender on the thumb side.
De Quervain’s tenosynovitis can occur in either wrist, regardless of whether it’s your dominant hand, and may even occur in both wrists at the same time.
When a Person Should Avoid Finkelstein Sign
This test doesn’t have any specific situations where it should absolutely not be done. However, it’s generally not recommended if there’s a chance that your wrist, radial (one of the two bones in your forearm), or ulnar (the other bone in your forearm) might be broken. It’s also not suggested if X-rays or other scans have already confirmed a break.
Equipment used for Finkelstein Sign
This test doesn’t require any special medical equipment. However, it should only be carried out by a trained healthcare professional in a comfortable setting. This could be a room where you can sit comfortably and rest your hand on an examination table. Alternatively, the test could be done next to your bed, with your hand hanging off the side or resting on the bed’s handrail.
Who is needed to perform Finkelstein Sign?
It’s important to realize that even though Finkelstein’s test has long been thought of as a signature indication for a particular wrist condition called De Quervain tendinopathy (a painful inflammation of the tendons on the thumb side of your wrist), most medical professionals and training guidelines actually describe a different test, known as Eichhoff’s test. This confusion goes all the way back to 1958, when Leao mixed up Eichhoff’s test with Finkelstein’s test.
In 1992, Eliott clarified the differences between Finkelstein’s test and its mistakenly described version, Eichhoff’s test. It’s important to know that Eichhoff’s test can sometimes give misleading results because it has the potential to cause pain in other areas of the wrist. This means it might falsely suggest you have the condition (false-positive) or falsely suggest you don’t have the condition (false-negative). For example, the patient might feel pain when bending their wrist in a certain way against resistance.
Finkelstein’s test, if done properly by your doctor, doesn’t lead to these misleading results. It’s more reliable in diagnosing De Quervain tendinopathy.
Preparing for Finkelstein Sign
At the start of the test, you, as the patient, will be seated in a comfortable and relaxed manner on the examination table. The doctor will first inspect your hands to check for any swelling or changes in shape on the thumb side of your wrist.
How is Finkelstein Sign performed
Dawson and his team in 2010 suggested a three-step method which is comfortable for patients and can accurately identify a condition called de Quervain’s synovitis (a painful inflammation of tendons on the thumb side of your wrist). To do this test, the patient’s affected arm is stretched out so that the wrist stays at the edge of the examination table. The arm is placed with the inside part of the forearm on the table and the inside part of the hand hanging off the edge, keeping the forearm in a relaxed position.
First, the patient’s pain level is checked by gently moving the wrist towards the little finger side without any extra help from the doctor (this movement, assisted by gravity, is known as active ulnar deviation). This version of the test is suitable for patients who have the initial symptoms of the condition. The test is considered positive if the patient feels increased pain at the tip of the small, bony prominence (radial styloid process) at the thumb side of the wrist.
If the patient doesn’t feel pain during this step, the doctor can gently move the patient’s hand towards the little finger side which results in a greater stretch across the thumb side of the wrist. This test is also considered positive if the patient reports increased pain at the bony prominence.
If the patient doesn’t feel any pain while conducting these two steps, the doctor can perform the original version of the test described by Finkelstein. This test is suitable for patients in the longstanding stage who are unlikely to feel significant pain in the first two steps. In this case, the doctor holds the patient’s thumb and then gently bends it into the palm. A positive test result is when the patient experiences increasing pain at the tip of the bony prominence on the thumb side of the wrist. Carrying out the test in these stages should result in fewer incorrect positive results as it is less forceful than Eichhoff’s test.
The Eichhoff test is performed with the patient’s forearm rested on the edge of the table just like during the Finkelstein test. The patient is asked to make a fist with the thumb inside the hand and hold it tightly with the other fingers. The doctor then gently moves the hand towards the little finger side. As it is a very forceful test, Eichhoff’s maneuver can produce a lot of incorrect positive test results, so it is not preferred over the three-stage Finkelstein test.
Possible Complications of Finkelstein Sign
When carried out correctly by a medical expert, this test is known to not have any problems or side effects.
What Else Should I Know About Finkelstein Sign?
De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist. Doctors can diagnose this condition using different tests, including the Finkelstein’s test and the Eichhoff’s test. Finkelstein’s test tends to be more accurate, but the actual reliability of this test isn’t fully understood due to a lack of extensive research on it. So, there’s a need for more large studies to determine its exact accuracy.
Once a diagnosis of De Quervain’s tenosynovitis is confirmed, doctors usually suggest non-invasive treatments first, like changing your activities and resting more to alleviate symptoms. If these methods don’t help, the doctor may suggest a thumb spica splint, which is a special type of brace that supports and immobilizes the thumb and wrist, and offers them plenty of rest.
If this measure also fails to provide relief, you might be given an injection of a medicine called corticosteroid to reduce inflammation and pain. Should the pain persist even after these treatments, the doctor might suggest surgery to release the APL, one of the tendons affected by this condition, to alleviate the symptoms.