De Quervain’s tenosynovitis “DQ” is a common pathologic condition of the hand that occured due to Inflammation of two tendons and their sheath that control movement of the thumb (APL, EPB). There are 2 tests using in diagnosis of the DQ tenosynovitis :
- Finkelstein’s test
- Eichhoff’s test
Finkelstein’s Test #
To perform the test, The arm is positioned with the ulnar aspect of the forearm on the table and the ulnar aspect of the hand dangling off the edge of the table. The forearm is kept in neutral.
- In the 1st step, the pain is appeared with gravity-assisted gentle active ulnar deviation at the wrist. This version is suitable for the acute phase.
- The 2ed step: If version one does not elicit pain, gently apply forced ulnar deviation to the hand, which results in an increased passive stretch across the first dorsal compartment .
If the 2ed step is still not provocating, go to the 3ed step which is suitable for patients in the chronic stage that present is likely to not have substantial pain in the first two steps.
- In the 3ed step, grasp the thumb and flex it passively into the palm.
A positive test: if the patient feels increased pain over the tip of the styloid process.
Eichhoff’s Test #
To perform this test, the patient should extend his affected extremity and rest it on the treatment table so that the wrist is dangling off of the table.
Then ask the patient to make a fist with the thumb inside his fist, stabilize the forearm on the table and gently deviate the wrist towards the ulnar side.
A Positive test : if the patient feels pain over the tendons of the extensor pollicis brevis and the abductor pollicis longus, which both form the medial base of the anatomical sniff box.
Finkelstein’s Test Is Superior to Eichhoff’s Test in the Investigation of de Quervain’s Disease #
The following study ” Finkelstein’s Test Is Superior to Eichhoff’s Test in the Investigation of de Quervain’s Disease” Published in 3 March 2018 and conducted by Feiran Wu, Asim Rajpura, and Dilraj Sandher.
The purpose of this study was to compare Finkelstein’s test with Eichhoff’s test in asymptomatic individuals.
Materials and Methods
Thirty-six asymptomatic participants (72 wrists) were examined using both Finkelstein’s and Eichhoff’s tests with a minimum interval of 24 hours between the tests.
A prospective controlled study was performed at the local university hospital. Over a 3-month period, asymptomatic individuals were invited to participate. Informed written consent was obtained from all participants. Patients were excluded if they suffered from a history of wrist pain, had a previous diagnosis of de Quervain’s tenosynovitis, had ever sustained a fracture of the distal radius, suffered from inflammatory arthropathy, or were diagnosed with intersection syndrome.
All patients underwent Finkelstein’s and Eichhoff’s tests as described in literature in both dominant and nondominant wrists. Each measurement was performed twice and the mean was recorded.
The examiner subsequently asked the patient to actively ulnarly deviate the wrist before grasping the patient’s thumb and passively flexing it into the palm ( Fig. 1 ).
Eichhoff’s test was performed by asking the participant to place the thumb within the hand and clench tightly with the other fingers. The hand was then passively abducted ulnarward by the examiner ( Fig. 2 ).
In both the tests, the examiner can also perform these maneuvers while palpating the abductor pollicis longus and extensor pollicis brevis tendons over the lateral radius and feeling for moving nodularity, tendon rub, or popping directly over the tendon. Participants were asked to grade the degree of pain they experienced on a linear visual analogue scale (VAS) from 0 to 100, with 0 being no pain and 100 being maximal pain. Findings of moderate or severe pain (44–100) was considered to be false positive.
Results The results showed that Finkelstein’s test was more accurate than Eichhoff’s test. It demonstrated higher specificity, produced significantly fewer numbers of false-positive results, and also caused significantly less discomfort to patients.
Conclusion This study recommends Finkelstein’s test as the clinical examination of choice for the diagnosis of de Quervain’s disease.
To read the orginal research click here