Brunelli Test

Context

De Quervain tenosynovitis affects the synovial sheaths of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons where they pass through a fibro-osseous tunnel in the first dorsal compartment of the wrist (Som et al., 2022).

One of the most common tests for diagnosing this condition is the Finkelstein Test, which was described in his article in 1930 (Elliott, 1992; Wu et al., 2018).

This test, which aims to reproduce pain at the radial styloid by flexing the thumb and ulnarly deviating the wrist, has been described as the most pathognomonic sign (Elliott, 1992; Wu et al., 2018).

However, some authors have questioned the diagnostic accuracy of this test. In his 2003 study, Brunelli expressed concern over calling the Finkelstein Test the most pathognomonic sign. The author notes that the Finkelstein Test is incorrect because, in De Quervain tenosynovitis, the pain would be caused by friction of the tendons in the first compartment against the pulley. However, the Finkelstein Test stretches the long abductor and short extensor tendons (Brunelli, 2003).

With this maneuver, the tendons are pressed against the floor of the first dorsal compartment and moved away from the pulley, while the radial collateral ligament, the scapho-trapezial ligament, and the first carpometacarpal ligament are also stretched and may cause pain unrelated to De Quervain tenosynovitis (Brunelli, 2003).

Brunelli created a test that he considers truly pathognomonic by causing friction of the tendons against the pulley.

Video of the Test

Execution

To perform the test, the patient will place their forearm in pro-supination. They will then perform a radial deviation of the wrist and forcefully extend the thumb in abduction. The tendons would then be applied against the pulley, creating friction during the thumb extension-abduction, which causes very sharp pain in case of a positive test (Brunelli, 2003).

Clinical Value

The author claims that this test is more pathognomonic and precise than the Finkelstein Test, but further studies are needed to establish its clinimetry.