De Quervain Syndrome Test – Everything You Need To Know – Dr. Nabil Ebraheim

Dr. Ebraheim’s animated educational video describing De Quervain syndrome – Finkelstein’s Test.
The Finkelstein’s Test is used to diagnose the condition of De Quervain syndrome (stenosing tenosynovitis of the first dorsal compartment of the wrist). The muscles of the first dorsal compartment of the wrist allow for thumb motion. The two tendons that are involved are the abductor pollicis longus and the extensor pollicis brevis. Remember, the extensor pollicis longus is located in the third compartment. With De Quervain syndrome, there will be pain and swelling over the radial side of the wrist (thumb side). It occurs due to inflammation, thickening, and stenosis of the synovial sheath. Inflammation of the synovial sheath (tunnel) that surrounds the two tendons that control movement of the thumb (abductor pollicis longus & extensor pollicis brevis). The physician will confirm the findings by doing the Finkelstein’s test.
The test is conducted by having the patient make a fist with the fingers closed over the thumb and the wrist is bent towards the little finger. An ulnarly directed force is then applied to the wrist to stretch the involved tendons. This is a provocative test that is done to stretch the involved tendons and see if the condition is painful or not. A positive test is indicated by sharp, local pain over the radial aspect of the wrist.
Activities that may cause De Quervain’s Syndrome include:
•Twisting/wringing out wet towels
•Hammering
•Skiing
•Lifting heave objects
•Caring for children
oPeople who care for babies and young children commonly experience De Quervain’s due to holding or carrying the child.
The physician should differentiate between De Quervain’s Syndrome, Intersection Syndrome, and Wartenberg’s Syndrome.
Finkelstein’s Test is used to diagnose De Quervain’s syndrome in patients who have pain on the radial side of the wrist.
Differential Diagnosis:
•Intersection Syndrome
oPain felt on the top of the forearm where two muscles that connect to the thumb cross over the underlying wrist tendons.
oPain is located about 4 cm from the wrist joint.
oThe two tendons of the wrist are the extensor carpi radialis longus and extensor carpi radialis brevis.
oPain is increased by extension and flexion of the wrist (felt more on the top of the forearm)
oIntersection syndrome pain is more proximal than the pain associated with De Quervain’s syndrome.
•Wartenberg’s Syndrome
oIrritation of the superficial branch of the radial nerve
oThe pain is located 8 cm proximal to the radial styloid
oThe patient will be unable to tolerate wearing a tight bracelet or a wrist watch
oThere will be pain in addition to numbness, tingling, and paresthesia on the posterior aspect of the thumb
oThe patient will not complain about weakness
oIf you tap over the area of the nerve, the patient will have symptoms (positive Tinel’s sign).

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