REIDER PART 1
65

Chaptkr 4 Hand and Wrist 155

Figurę 4-89. Grind test of the basilar joint.

the patient’s pain or results in a palpable grinding sensa-tion, this is evidence for degenerative arthritis of the basilar joint.

FlNKELSTEIN^yS TEST

The Finkelstein test is a provocative test to evoke the symptoms of de Quervains disease, the eponym for tenosynovitis of the first dorsal compartment, which con-tains the abductor pollicis longus and extensor pollicis brevis tendons. Finkelstein s test is usually performed with the patient’s elbow flexed and the forearm in a posi-tion of neutral rotation so that the dorsal surface of the thumb faces upward. The patient is then instructed to flex the thumb across the palm (Fig. 4-90A) and then to ulnar-deviate the wrist (Fig. 4-90B). In the normal patient, this maneuver should not be uncomfortable. In the presence of de Quervain’s disease, this maneuver usually produces a severe exacerbation of the patienfs pain. Many authors recommend performing the ulnar devia-tion passively, but this may be excessively painful for a patient with de Quervains tenosynovitis.

Transillumination

Transillumination is a technique for verifying that a pro-truding mass at the wrist or the hand is a gangiion cyst. The transillumination test is not useful for tiny ganglia. Transillumination of a ganglion is best performed in a darkcncd room. The cxaminer places the lighted end of a penlight flashlight against the cutaneous surface next to the mass. If the mass is indeed a ganglion, the light should be seen to pass through it, changing the glow of the light from a round to a dumbbell-shaped globe. This demon-strates that the mass is indeed a cyst filled with fluid, and thus it is almost certainly a ganglion. If, on the other hand, the mass does not transmit the light, it is probably a solid mass and not a ganglion.

Evaluation of Circulation

Capillary Refill. The most basie test for evaluating the circulation to the fingers is to assess the capillary refill. Circulation to the fingers or the hands in generał may be compromised by peripheral vascular disease, Raynaud’s disease, or local arterial injury. Capillary refill is assessed with the patients hand pronated. The examiner first notes the color of the nailbed of the finger to be evalu-ated. Normally, the nailbed should have a healthy pink tinge, reflecting good capillary perfusion. The examiner then compresses the patienfs fingertip between the examiner’s own thumb and index finger for a few seconds (Fig. 4-9 M). This compression serves to empty most of the blood from the capiilaries of the patienfs fingertip. The examiner then suddenly uncovers the patienfs nailbed and observes its color (Fig. 4-9IB). When the patienfs nailbed is first uncovered, it should appear blanched compared with the other fingers and compared with its previous color. The normal pink color should,

A    B

Figurę 4-90. A and B, Finkelstein^ test.