Finkelstein's test is used to detect de Quervain's tenosynovitis by reproducing pain in the wrist during ulnar deviation when the thumb is flexed and fingers closed over it. Phalen's test increases pressure on the median nerve in the carpal tunnel by flexing the wrists to reproduce paraesthesiae in the median nerve distribution, indicating carpal tunnel syndrome. Tinel's test elicits paraesthesiae or pain in the median nerve distribution by tapping over the carpal tunnel to aid in diagnosing carpal tunnel syndrome.

1. WRIST JOINT
MSK Special Tests
Dr.Ambreen Zahid
Senior Lecturer

2. Finkelstein’s test
Purpose
• To detect pain and limitation caused by inflammation between the
tendons of abductor pollicis longus (APL) and extensor pollicis
brevis (EPB) and their shared synovial sheath at the distal end of the
radius (de Quervain’s tenosynovitis).
Technique
Patient position
• With the forearm positioned in pronation, the patient is asked to
flex the thumb and close their fingers over it.
Clinician position and action
• The lower forearm is fixed with one hand and the patient’s hand
taken into ulnar deviation passively with the other.
Positive test
• As the wrist is taken towards ulnar deviation, significant pain is
reproduced over the radial aspect of the wrist.

3. Finkelstein’s test.

4. Phalen’s test
Purpose
• To increase pressure on the median nerve as it passes
through the carpal tunnel in order to aid diagnosis of
carpal tunnel syndrome (CTS).
Technique
Patient position
• Seated with the hand resting on a table in mid-
pronation.
Clinician position
• Seated facing the patient. The affected hand is taken
into full wrist flexion. Alternatively, the patient is asked
to flex both wrists and oppose the dorsum of the hands
so that the flexion is maintained bilaterally.

5. Action
• In either position, the wrist flexion is maintained
for a minute
Positive test
• Paraesthesiae is reproduced in the cutaneous
distribution of the median nerve (the palmar
aspect of the thumb, index and middle fingers
and the lateral half of the ring finger) as a result
of the sustained narrowing at the carpal tunnel
during flexion of the wrist. If severe, pain may
also be reproduced.

6. Phalen’s test (A). Phalen’s test
alternative position (B).

7. Tinel’s test
Purpose
• To elicit paraesthesiae and/or pain in the median nerve
distribution of the hand in order to aid diagnosis of carpal
tunnel syndrome (CTS).
Technique
Patient position
• Seated with the hand resting on a table with the forearm
fully supinated.
Clinician position
• Sitting facing the patient, the affected hand is held in a
neutral position.
Action
• The mid-point of the carpal tunnel is identified and
‘tapped’ with a finger or a percussion hammer.

8. Tinel’s test at the carpal tunnel.