A test for diagnosing de Quervain’s tenosynovitis, or snapping thumb syndrome.
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 pp522]
*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 augmented which 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 see pp513]
- Modified Eichhoff test
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.[PMID 1402284]
- Eichhoff, E. Zur Pathogenese der Tendovaginitis stenosans. Bruns’ Beitr z klin Chir 139, 746-755, 1927
- Finkelstein H. Stenosing tendovaginitis at the radial styloid process. JBJS 1930, 12: 509-540.
- Aitken AP. Stenosing Tendovaginitis at the Radial Styloid Process (de Quervain’s Disease). N Engl J Med 1945; 232:105-107
- Waseem M, Khan M, Hussain N, Giannoudis PV, Fischer J, Smith RM. Eponyms: errors in clinical practice and scientific writing. Acta Orthop Belg. 2005 Feb;71(1):1-8. [PMID 15792200]
- Elliott BG. Finkelstein’s test: A descriptive error that can produce a false positive. J Hand Surg Br. 1992 Aug;17(4):481-2.[PMID 1402284]
- Leao L. De Quervain’s disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958 Oct;40-A(5):1063-70. [PMID 13587574]
- Arend CF. Tenosynovitis and synovitis of the first extensor compartment of the wrist: what sonographers should know. Radiol Bras vol.45 no.4 São Paulo June./Aug. 2012
- Goubau JF et al. 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. [PMID 23340762]
LITFL Related Links
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