Diagnostic Test for De Quervain's Tenosynovitis
The Finkelstein test is the diagnostic test of choice for De Quervain's tenosynovitis, as it demonstrates superior specificity with fewer false-positive results compared to the commonly misused Eichhoff test. 1
Clinical Examination Approach
Primary Diagnostic Test: Finkelstein Test
- Finkelstein's test should be performed as the primary clinical examination for suspected De Quervain's disease, as it produces significantly fewer false-positive results and causes less discomfort to patients compared to Eichhoff's test 1
- The test has 97% sensitivity and demonstrates pathognomonic findings for this condition 2
- The test specifically evaluates the extensor pollicis brevis (EPB) tendon, which shows significantly greater bulk and tethering effect in the position of Finkelstein's test 3
Important Distinction: Finkelstein vs Eichhoff
- Most clinicians erroneously perform Eichhoff's test while calling it Finkelstein's test - these are different maneuvers 1
- Eichhoff's test (thumb flexed into palm with ulnar deviation) has only 74% specificity and produces pain in normal wrists through tendon stretching 2
- Finkelstein's test (proper technique) has 99% specificity, making it far more reliable 2
Adjunctive Clinical Test
- The radial synergy test can serve as a highly specific adjunct (99% specificity) when diagnostic uncertainty exists 2
- This test uses isometric contraction of the first dorsal compartment with resisted small finger abduction 2
Imaging Confirmation When Needed
First-Line Imaging: Ultrasound
- Ultrasound is the appropriate imaging modality when clinical diagnosis requires confirmation or when evaluating for anatomic variants that affect surgical planning 4
- US can identify septations or subcompartmentalization within the first dorsal compartment, which affects surgical management 4
- The American College of Radiology recommends US for suspected De Quervain disease (stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis) 4
Advanced Imaging: MRI
- MRI without IV contrast is appropriate when extra-articular pathology requires comprehensive evaluation 4
- MRI can diagnose tenosynovitis and tendon abnormalities with high accuracy 4
- However, imaging is typically not necessary when clinical examination is clearly positive 5
Clinical Diagnosis Confirmation
- Diagnosis is primarily clinical based on physical examination findings 5
- Pain at the radial styloid with resisted gliding of the abductor pollicis longus and extensor pollicis brevis tendons is characteristic 5
- Radiographs are only helpful to rule out bony pathology, not to diagnose De Quervain's itself 5
Common Pitfall to Avoid
The most critical error is performing Eichhoff's test (thumb in fist with ulnar deviation) instead of the proper Finkelstein test, which leads to false-positive results in asymptomatic individuals and unnecessary treatment 1, 6