A test for diagnosing de Quervain tenosynovitis, or snapping thumb syndrome.
Confusion exists over the exact description of performing Finkelstein’s test as opposed to Eichhoff Test – a descriptive error that can produce a false positive. [J Hand Surg Br, 1992]
History of the Finkelstein Test
1930 – Review of surgical operation, histology and clinical examination led Finkelstein to summise
On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is excruciating. This is probably the most pathognomonic objective sign.Finkelstein H. JBJS 1930: 522
*1927 – An alternative test suggested by E. Eichhoff was accurately transposed from the German and quoted in Finkelstein’s 1930 paper in full. This led to confusion regarding the anatomics of the testing procedure aggravated by a poor description of the test by Leão (1958); and further augmented by later authors.
A simple experiment will verify this assumption. If one places the thumb within the hand, and holds it tightly with the fingers, and then bends the hand severely, in ulnar abduction, an intense pain is experienced on the styloid process of the radius, exactly at the place where the tendon sheath takes its course. The pain disappears the moment the thumb is extended, even if the ulnar abduction is maintained. In cases of forced abduction of the hand, without simultaneous involvement of the thumb, one does not succeed in evoking this pain. Thus, repeated overstretching of the tendon sheath results in injury to the gliding mechanism.Eichhoff E. 1927: 513
- Modified Eichhoff test
- Eichhoff E. Zur Pathogenese der Tendovaginitis stenosans. Bruns’ Beiträge zur klinischen Chirurgie 1927; 139: 746-755
- Finkelstein H. Stenosing tendovaginitis at the radial styloid process. JBJS 1930, 12: 509-540.
- Leao L. De Quervain’s disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958 Oct;40-A(5):1063-70.
- Aitken AP. Stenosing Tendovaginitis at the Radial Styloid Process (de Quervain’s Disease). N Engl J Med 1945; 232:105-107
- Elliott BG. Finkelstein’s test: A descriptive error that can produce a false positive. J Hand Surg Br. 1992;17(4):481-2
- Waseem M, Khan M, Hussain N, Giannoudis PV, Fischer J, Smith RM. Eponyms: errors in clinical practice and scientific writing. Acta Orthop Belg. 2005;71(1):1-8
- Arend CF. Tenosynovitis and synovitis of the first extensor compartment of the wrist: what sonographers should know. Radiol Bras 2012; 45(4)
- Goubau JF, Goubau L, Van Tongel A, Van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. J Hand Surg Eur Vol. 2014 Mar;39(3):286-92
- Wu F, Rajpura A, Sandher D. Finkelstein’s Test Is Superior to Eichhoff’s Test in the Investigation of de Quervain’s Disease. J Hand Microsurg. 2018 Aug;10(2):116-118
the names behind the name
Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |