Hand Surgery Source

First Extensor Compartment Tenderness

Test, Exam and Signs

Historical Overview

  • The fist extensor compartment of the wrist contains the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL); tenderness in this region is indicative of tenosynovitis.
  • This condition is generally referred to as de Quervain’s tenosynovitis. de Quervain first described the disease, as “stenosing tendovaginitis at the radial styloid process,” in 18951.

Description

  • Tenderness at the first extensor compartment, around the radial styloid process
  • Catching or triggering of the tendons may also be present

Pathophysiology

  • Inflammation of the EPB/APL tendons and/or their synovial sheaths results in interference with, and thickening of, the fibrous sheath of the first extensor compartment. This causes pain and interferes with tendon function, sometimes resulting in catching or triggering of the tendons.

Instructions

  1. Take patient history
  2. Palpate the first extensor compartment at the radial styloid

Variations

  • Eichoff: flexed thumb held in patient’s fist
  • Finkelstein2: elicit pain by forcing the involved tendons against the radial styloid process
  • Brunelli3: elicits pain by forcing the involved tendons against the pulley formed by the dorsal carpal ligament

Related Signs and Tests

  • Grind test
  • Second extensor compartment tenderness

Diagnostic Performance Characteristics

  • As the involve structures are superficial, palpation of the first compartment is straightforward. Suspicion of de Quervain’s tenosynovitis can be confirmed by provocative testing.
Presentation Photos and Related Diagrams
  • Thumb palpating first extensor compartment for tenderness
    Thumb palpating first extensor compartment for tenderness
  • Thumb palpating first extensor compartment for tenderness
    Thumb palpating first extensor compartment for tenderness
Definition of Positive Result
  • A positive result occurs when pain is elicited with increased pressure.
Definition of Negative Result
  • Finkelstein’s test has been routinely misdescribed and confused with Eichoff’s test.2
Comments and Pearls
  • Finkelstein’s test has been routinely misdescribed and confused with Eichoff’s test.2
Diagnoses Associated with Tests, Exams and Signs
YouTube Videos
DeQuervain's Tenosynovitis
References
  1. de Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop 1997;26(9):641-644 PMID: 9316729. PMID: 9316729
  2. Dawson C, Mudgal CS. Staged description of the finkelstein test. J Hand Surg Am 2010;35(9):1513-1515. PMID: 20709467
  3. Brunelli G. [Finkelstein's versus brunelli's test in de Quervain tenosynovitis] French. Chir Main 2003;22(1):43-45. PMID: 12723309