Finkelstein Test
This test is conducted when De Quervain syndrome is suspected (tenosynovitis of the abductor pollicis longus muscle and the extensor pollicis brevis muscle).
Procedure
- Holding the wrist of the patient, carry out passive ulnar abduction, leaving the thumb free. The patient will indicate no pain or mild pain at the level of the radial styloid process [Figure 137].
Figure 137
- Then, carry out passive abduction of the patient’s wrist again, but this time ask the patient to hold the thumb inside the fist [Figure 138].
Figure 138
- The test is positive if the pain symptoms increase during the latter.
Test For Suspected Carpal Tunnel Syndrome
These tests are indicated when a patient complains about tingling and/or pain and/or loss of strength in the hand (atrophy of the thenar).
Tinel’s Sign
- The investigator taps with the middle finger or a reflex hammer at the level of the carpal ligament (palmar side) on the middle of the patient’s wrist.
- The wrist should be in slight dorsiflexion during this procedure.
- A tingling feeling in the area of the median nerve is typical when one taps on, or just proximally to, the affected location, along the pathway of the nerve [Figure 139].
- The symptom is said to be positive if the same pain and/or tingling as previously reported by the patient can be induced (median nerve distribution).
Figure 139
Phalen Manoeuvre
- Ask the patient to hold the backs of both hands against each other (maximum palmar flexion) for at least one minute [Figure 140].
Figure 140
- Ask the patient to hold the palms of both hands against each other (maximum dorsal flexion) for at least one minute [Figure 141].
Figure 141
- The test is positive if during exercise 1 and/or 2 the same tingling and/or pain symptoms as previously reported by the patient develop (median nerve distribution).
- One has to realise that these tests often result in false-negative and false-positive outcomes (poor sensitivity and specificity).
- History-taking and EMG (electromyography) often provide a definitive answer.