Finkelstein Test: Clinical Application for Physical Therapists

Wrist and thumb pain are frequent complaints in outpatient rehabilitation, especially among patients engaged in repetitive lifting, texting, gripping, or caregiving activities. One commonly encountered condition is De Quervain’s tenosynovitis, an overuse injury that causes pain along the radial side of the wrist. The Finkelstein Test is a straightforward orthopedic maneuver that helps identify this condition and informs early treatment decisions in physical therapy.

This article outlines the purpose of the Finkelstein Test, how to perform it accurately, when to apply it, and how to use the findings to shape clinical care. A real-world patient scenario is also included to show how the test integrates into practice.

What Is the Finkelstein Test?

The Finkelstein Test is a provocative maneuver used to assess inflammation in the tendon sheath of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscles. These tendons travel together in the first dorsal compartment of the wrist and contribute to thumb movement. When this sheath becomes irritated—often due to repetitive motion or overuse—patients may experience pain with thumb movement, gripping, or lifting.

This test helps confirm whether radial-sided wrist pain may be linked to De Quervain’s tenosynovitis by stretching the involved tendons and observing the pain response.

How to Perform the Finkelstein Test

To perform the test:

1. Ask the patient to relax the arm while seated or standing.

2. Position the patient’s thumb inside a closed fist (the fingers wrapped over the thumb).

3. Gently deviate the patient’s wrist toward the ulnar side (pinky direction).

4. Observe the patient’s pain response and note the location of any symptoms.

A positive test occurs when the patient reports sharp or localized pain over the radial styloid. It’s helpful to test both wrists for comparison and to clarify whether the discomfort is consistent with their typical symptoms.

When to Use the Finkelstein Test

The Finkelstein Test is most useful when a patient presents with:

• Gradual-onset pain at the base of the thumb or radial wrist

• Tenderness or swelling near the radial styloid

• Discomfort during lifting, grasping, or pinching tasks

• Recent increase in repetitive hand activity (e.g., caring for a newborn, using tools, or prolonged smartphone use)

In these cases, the test can confirm suspicions of tendon sheath irritation and guide initial management decisions such as splinting, rest, or therapeutic exercise.

Clinical Example: Applying the Test in Practice

Scenario:
A 34-year-old new mother presents with wrist pain that began six weeks ago. She reports sharp pain when picking up her baby or wringing out a washcloth.

Assessment:
During the Finkelstein Test, the therapist positions the patient’s thumb inside her fist and slowly deviates the wrist ulnarly. The patient reports sharp pain along the radial side of the wrist, replicating her daily discomfort.

Clinical Outcome:
Based on this result, the therapist initiates a treatment plan including thumb-spica splinting, education on lifting techniques, and tendon gliding exercises. The patient is also advised to modify repetitive tasks and receive guidance on pacing strategies at home.

Clinical Considerations and Limitations

While the Finkelstein Test can help identify De Quervain’s tenosynovitis, it is not diagnostic in isolation. It should be interpreted within the context of:

• Patient history and symptom pattern

• Palpation of the wrist and thumb musculature

• Strength and range of motion testing

• Functional limitations
  

In some cases, adjacent structures such as the first carpometacarpal (CMC) joint or other tendons can also reproduce pain during the test. Using multiple exam components allows the therapist to confirm the diagnosis with greater confidence.

How the Test Supports Physical Therapy Treatment Planning

For physical therapists, the Finkelstein Test serves several purposes:

• Identifies the involvement of specific tendons during evaluation

• Guides initial treatment interventions, including activity modification and splinting

• Tracks progress during re-evaluation by monitoring pain response

• Helps educate patients about their condition and reinforces clinical reasoning
  

By integrating the test into a comprehensive wrist and hand evaluation, therapists can tailor care plans more effectively and support faster return to function.

The Finkelstein Test is a simple, fast, and clinically relevant tool for assessing radial wrist pain in patients suspected of having De Quervain’s tenosynovitis. When used appropriately and interpreted in the context of a full evaluation, it supports accurate clinical decision-making and helps therapists deliver targeted, functional care.

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