Houston Methodist. Leading Medicine

Wrist FAQ

Question:

I found out the hard way that I have something called de Quervain's. My wrist was already hurting when I went in for the examination. The test to prove what was wrong was intensely excruciating. Is it really necessary to put people through such pain? Can't they just take my word for it that the wrist hurts?

Answer:

It might be helpful if you understand a little about the biomechanics of de Quervain's and what makes it hurt. That will help explain why the test is needed to confirm the diagnosis. De Quervain's tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole. This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. Three changes occur in the tendons (as observed during surgery for this problem): thickening of the tendon sheath, enlargement of the tendons, and thickening of ttenosynovium. In de Quervain's tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel. Most likely the test you performed is called Finkelstein's test. You may have been asked to put your hand in a thumbs-up position then to tuck your thumb in your palm and move the hand down toward the floor. It causes a stretch to the inflamed tendons. As the affected tendons are forced to move through the constricted area and over the bone underneath, pain is produced. But as you suspected, there is a way to perform this test without causing so much pain to the patient while still getting the information needed for the diagnosis. It's called the staged Finkelstein's test. The test is done like so: your hand is placed on the edge of a table (or arm rest on a chair). The wrist is supported but the hand is off the edge of the supporting surface. The patient is asked to tilt his or her hand down toward the floor. That is step (or stage) one. The examiner will then gently grasp your hand and passively (without your help) move the wrist a little farther in the downward direction. The final step is for the examiner to press down on your thumb (moving it toward your palm). Neither one of these last two steps is performed if you (or the patient) has pain with the first step. Hopefully, in time everyone will know about the change in this test that allows for a less painful but still accurate diagnosis. Courtney Dawson, MD, and Chaitanya S. Mudgal, MD. Staged Description of the Finkelstein Test. In The Journal of Hand Surgery. September 2010. Vol. 35A. No. 9. Pp. 1513-1515.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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