Finkelstein test - Passive Stretching of extensor thumb tendons. III. Indication. De Quervain's Tenosynovitis assessment. IV. Technique: Finkelstein's Test (preferred, higher Test Specificity) Examiner braces wrist in ulnar deviation. Examiner passively flexes thumb across palm.

 
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However, Finkelstein's test can also be positive in those suffering from osteoarthritis, so further assessment may be necessary. Who suffers from de Quervain's?Finkelstein’s Test # To perform the test, The arm is positioned with the ulnar aspect of the forearm on the table and the ulnar aspect of the hand dangling off the edge of the table. The forearm is kept in neutral. In the 1st step, the pain is appeared with gravity-assisted gentle active ulnar deviation at the wrist. This version is suitable for the …However, there are discrepancies in the published literature regarding the Finkelstein test versus the Eichhoff test. Wu et al stated that in diagnosing de Quervain tenosynovitis, the Finkelstein test is often performed incorrectly, as the clinician in many cases is instead unknowingly performing the Eichhoff test. [] To perform the Finklestein …Sodium Iodide (Finkelstein) Test. A solution of sodium iodide in acetone is a test for some alkyl chlorides and bromides. The mechanism is largely \(S_\text{N}2\), so primary alkyl halides react faster than secondary alkyl halides, and tertiary alkyl halides generally give no reaction. The reaction is driven by the precipitation of the \(\ce ...Experts consider the Finkelstein test more accurate than Eichhoff’s test. More large studies are needed to assess its accuracy. In a small 2019 study, researchers found false positives in 46.7% of cases of Finkelstein tests and 53.3% of cases of Eichhoff’s tests. See moreMay 22, 2019 ... The Finkelstein test (thumb held in palm and wrist strongly ulnarly deviated) typically elicits pain, localized to the radial styloid.There is usually a positive Finkelstein test (pain on passive ulnar deviation) although this is not pathognomonic. Triggering or crepitus may also be elicited 3. Pathology. The APL and EPB tendons are tightly secured against the radial styloid by the overlying extensor retinaculum which creates a fibro-osseous tunnel approximately 1 cm in length …The Finkelstein test requires the patient to place the thumb in palmar flexion while the examiner does ulnar deviation of the wrist. A positive test is indicated by the induction of sharp pain along the radial wrist at the first dorsal compartment. The Eichhoff test involves asking the patient to clench the thumb with the other fingers while …Piers Morgan Uncensored is joined by author and political scientist Dr Norman Finkelstein after being one of our most highly-requested guests to cover the Is...Finkelstein's test is a clinical test used to diagnose De Quervain’s disease, which is a painful condition that affects the tendons in the wrist near the base of the thumb. De Quervain’s disease is caused by inflammation of the tendons that control the movement of the thumb. Procedure: Ask the patient to make a fist with their thumb inside their fingers.Definition/Description Anatomical snuffbox De Quervain's Tenosynovitis is a painful, inflammatory condition caused by tendons on the side of the wrist at the base of …The Finkelstein test, Wrist Hyperflexion and Abduction of the Thumb test (WHAT) and the Eichhoff test were performed by two clinical physiotherapists. Any pain reported was measured using a VAS ...The Finkelstein test is done to make sure that you do not have a different problem, such as arthritis in the bottom of your thumb or intersection syndrome. Both of these problems affect the same area of the hand and wrist as de Quervain's. How is de Quervain's tenosynovitis treated?Dr. Ebraheim's animated educational video describing De Quervain syndrome - Finkelstein's Test.The Finkelstein’s Test is used to diagnose the condition of De... The Finkelstein test has been described and taught to trainees (orthopedic surgeons, physical therapists, occupational therapists, athletic trainers) several different ways. The most common is the one you tried on yourself. But the test can be very painful and isn’t as specific as needed for an accurate diagnosis.Norman Gary Finkelstein ( / ˈfɪŋkəlstiːn / FING-kəl-steen; born December 8, 1953) is an American political scientist and activist. His primary fields of research are the politics of the Holocaust and the Israeli–Palestinian conflict. Finkelstein was born to parents who are both Jewish Holocaust survivors in New York City in 1953. There is usually a positive Finkelstein test (pain on passive ulnar deviation) although this is not pathognomonic. Triggering or crepitus may also be elicited 3. Pathology. The APL and EPB tendons are tightly secured against the radial styloid by the overlying extensor retinaculum which creates a fibro-osseous tunnel approximately 1 cm in length …Nov 26, 2010 · Procedure Steps. Instruct the patient to make a fist with their thumb covered-up inside. Examiner gently moves the hand/wrist into ulnar deviation. Sharp pain at the distal radial wrist = De Quervain’s tenosynovitis. Note: May be uncomfortable/painful on the asymptomatic side too. Compare the pain on the suspected side to the asymptomatic side. Introduction. The hand and wrist form a group of complex, delicately balanced joints which are considered the most active portion of the upper extremity. Optimal overall function is important to so many activities of daily living. A hand and wrist examination done in a structured manner will help to facilitate the most appropriate working ...A positive Finkelstein test. Phalen test. Instruct the patient to abduct their shoulders to 90º, flex the elbows and flex the wrists to oppose the dorsal surfaces of both wrists while both arms remain parallel to the ground. This position is then held for approximately 60 seconds. This test assesses for carpal tunnel syndrome. The test is positive if there is numbness, …Finkelstein's test was more specific than Eichhoff's test, with a specificity of 100%, compared with 89% for Eichhoff's test. # Discussion. This study confirmed that the hypothesis that Finkelstein's test is more accurate than Eichhoff's test and produced fewer false-positive results. Apart from being less specific, Eichhoff's test also produced a …The Finkelstein test, Wrist Hyperflexion and Abduction of the Thumb test (WHAT) and the Eichhoff test were performed by two clinical physiotherapists. Any pain reported was measured using a VAS ...Published by Elsevier Inc. We have revisited the original description of the Finkelstein test and review the reasons for its subsequent erroneous description. We have also outlined a staged description of this test, which we have found to be reliable and minimally painful for the diagnosis of de Quervain's tendonitis within o …. Aug 4, 2022 · A Finkelstein test is a simple way to diagnose de Quervain tenosynovitis, a condition that causes thumb pain and swelling. It involves bending your thumb across the palm of your hand and bending your fingers down over it. If you feel pain on the thumb side of your wrist, you likely have de Quervain tenosynovitis. Learn more about symptoms, causes, treatment and prevention. Jan 1, 2020 ... Finkelstein's test (deviating the wrist to the ulnar side, while grasping the thumb, resulting in pain) is in typical cases positive. In our ...Are you considering taking the Paraprofessional Test? If so, you’ve come to the right place. This article will provide an overview of what you need to know about taking the Parapro...Finkelstein test Pasien disuruh membuat kepalan tangan, dengan cara jempol masuk ke dalam kepalan. Kemudian tangan pemeriksa sebelah kiri memegang antebrachii pasien, tangan kanan pemeriksa menggerakkan wrist ke arah deviasi ulnar. Positif : bila pasien merasakan nyeri.Finkelstein’s Test. There is some controversy around this first test. Finkelstein originally described grasping the thumb and pulling in traction and ulnar deviation. This is the original Finkelstein’s. Eventually, Eichoff suggested what is now recognized as Finkelstein’s test. In this iteration, the patient makes a fist around their ...Aug 4, 2022 · A Finkelstein test is a simple way to diagnose de Quervain tenosynovitis, a condition that causes thumb pain and swelling. It involves bending your thumb across the palm of your hand and bending your fingers down over it. If you feel pain on the thumb side of your wrist, you likely have de Quervain tenosynovitis. Learn more about symptoms, causes, treatment and prevention. Check out this video to get an understanding of this important test for the wrist joint, to help you diagnose De Quervens Syndrome. It teaches you the method...Harry Finkelstein, an American surgeon, described the Finkelstein's test or Finkelstein's sign in 1930. It is a provocative test for diagnosis of De Quervain disease that can easily be performed in an …A variation of Finkelstein Test can be used to rule out an incomplete release of previous de Quervain disease. If the usual Finkelstein’s Test is positive, full abduction of the Abductor pollicis longus (APL) followed by flexion of the thumb’s MCP joint will isolate the action of the EPB. Pain with this test will occur if the Extensor ...Finkelstein Test. Figure 2. Finkelstein Test. The thumb is placed in the palm of hand, and the fingers are flexed firmly over it. On ulnar flexion in cases of DcQuervain's disease, acute pain is ...used to test for pathology at the thumb carpometacarpal joint (CMC) examiners applies axial load to first metacarpal and rotates or "grinds" it. positive findings: pain, crepitus, instability. Finkelstein's. used to test for DeQuervain's tenosynovitis. patient makes fist with fingers overlying thumb. examiner gently ulnarly deviates the wrist. …May 20, 2019 ... Check out this video to get an understanding of this important test for the wrist joint, to help you diagnose De Quervens Syndrome.Finkelstein's original description. The examiner grasps the patients thumb. They then pull in ulnar deviation and longitudinal traction. Commonly accepted alternative (in reality this is Eichhoffs Test ) The patient is asked to make a fist around their thumb with wrist in a neutral position. They then actively or passively apply ulnar deviation.Harry Finkelstein, an American surgeon (1865–1939), described the Finkelstein's test or Finkelstein's sign in 1930. It is a provocative test for diagnosis of...The Finkelstein Test. De Quervain's tenosynovitis is diagnosed after a simple examination by a doctor. A doctor will examine the thumb and wrist for swelling, and apply gentle pressure to the base ...Der Finkelstein-Test ist ein klinischer Test in der Orthopädie, der hinweisend für eine Quervain-Tendovaginitis ist.Finkelstein's test produces severe tenderness and usually pain on the radial aspect of the wrist when the thumb is flexed into the palm and the wrist is ulnar deviated. De Quervain's disease is commonly associated with the repetitive motions that place stress on the wrist; it is ommonly associated with professions such as restaurant servers.Wartenberg's Syndrome, also called "cheiralgia paresthetica," is a compressive neuropathy of the superficial sensory radial nerve at the wrist. Diagnosis is made clinically with pain and paresthesias over the dorsoradial hand without any motor deficits. Treatment is conservative with rest, wrist splints and CSIs with surgical …Finkelsteinin testi. Finkelsteinin testi on testi, jota käytetään diagnosoimaan De Quervainin jännetuppitulehdus. [1] [2] Testissä peukalo sijoitetaan suljettuun nyrkkiin ja rannetta taivutetaan sivusuunnassa alaspäin niin, että pikkurilli osoittaa alaspäin. Mikäli testi aiheuttaa potilaalle voimakasta kipua, on tulos todennäköisesti ...Are you considering taking the Paraprofessional Test? If so, you’ve come to the right place. This article will provide an overview of what you need to know about taking the Parapro...Are you curious about how fast you can type? Would you like to know if your typing speed is above average? Look no further. With the availability of free online typing speed tests,...Are you preparing to take the Duolingo English Practice Test? If so, you’ll want to make sure you’re as prepared as possible. Here are some top tips to help you get ready for your ...Finkelstein maneuver is a helpful test to diagnose De Quervain's Tendonitis or first dorsal compartment tendonitis named after the Swiss surgeon Fritz de Quervain. This is a condition brought on by irritation or inflammation of the wrist tendons at the base of the thumb. The inflammation causes the compartment (a tunnel or a sheath) around the ...Would you like to learn how to perform the Finkelstein's test with Paul Marquis PT? Here it is. Not only do I show how to perform the test, but I explain how...Apr 10, 2022 · de Quervain’s tenosynovitis is a common pathology that involves swelling and thickening of the tendon sheaths in the first dorsal compartment of the wrist. Eichoff’s test (often incorrectly referred to as Finkelstein’s test) is routinely used as part of the physical exam for de Quervain’s, but may cause pain in an asymptomatic population. Finkelstein's test. 1. has long been considered to be a pathognomonic sign of this diagnosis and is routinely taught to all trainees involved in musculoskeletal care, in the earliest stages of training. It is imperative that trainees understand that this test can cause considerable discomfort when performed.Finkelstein’s test is the classic diagnostic test for de Quervain’s disease. Finkelstein hypothesized that the entry of the muscle bellies of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons into the first extensor compartment was responsible for the findings observed in his now eponymous test. We agree with ...Lateral wrist pain, tenderness over radial styloid, positive Finkelstein’s test: Distal radius fracture: Local tenderness and deformity, abnormal plain radiographs: Extensor carpi radialis strain:El test de Finkelstein es la prueba distintiva para diagnosticar esta patología, aunque no se conocen valores de validez. Por lo tanto, el valor clínico de esta prueba es cuestionable. …The sensitivity and specificity of the modified staged Finkelstein test were 88.5% and 73.1%, respectively; those of EPB entrapment test were 71.4% and 84.2%, respectively. The positive and negative predictive values of the modified staged Finkelstein test were 76.7% and 86.4%, respectively. Conclusions: The modified staged Finkelstein test …Nov 26, 2010 · Procedure Steps. Instruct the patient to make a fist with their thumb covered-up inside. Examiner gently moves the hand/wrist into ulnar deviation. Sharp pain at the distal radial wrist = De Quervain’s tenosynovitis. Note: May be uncomfortable/painful on the asymptomatic side too. Compare the pain on the suspected side to the asymptomatic side. Are you considering taking a free online reasoning test? If so, you’re on the right track. A free online reasoning test can offer numerous benefits that can help you in various asp...Compete against other talented typists around the globe and show where the best typists come from. Each country has its own league and you can advance higher in the rankings by completing races and collecting points. Start the Race! TypingTest.com offers a free online Typing Test and exciting typing games and keyboarding practice.Feb 25, 2023 ... There is usually a positive Finkelstein test (pain on passive ulnar deviation) although this is not pathognomonic. Triggering or crepitus ...The Finkelstein test, Wrist Hyperflexion and Abduction of the Thumb test (WHAT) and the Eichhoff test were performed by two clinical physiotherapists. Any pain reported was measured using a VAS ...Dec 17, 2023 · A simple test—the Finkelstein test—which is performed as follows, can help determine if a person has de Quervain's tenosynovitis: Make a fist with the thumb tucked under the fingers. Tilt the wrist toward the pinky side of the hand (like using a hammer). If there is pain along the thumb side of the wrist, the test is considered positive. Richmond, VA. Change Server. Connections. Multi Single. Use Speedtest ® on all your devices with our free native apps. Download Speedtest apps for: Android. iOS. Windows.If the patient's symptoms permit, provocative testing for tendinopathy and ligamentous laxity can be done. The Finkelstein test is done to look for De Quervain syndrome De Quervain Syndrome De Quervain syndrome is stenosing tenosynovitis of the short extensor tendon (extensor pollicis brevis) and long abductor tendon (abductor pollicis longus) of the thumb within the first extensor... Nov 10, 2019 · Exacerbation of the symptomatology is considered a positive test result”. The Skinny- When choosing a provocative test for De Quervain’s disease (De Quervain’s Tenosynovitis Test), therapists in the past have typically chosen from two popular tests; Eichoff’s test and Finkelstein’s test. The latter often being confused with the first. The Finkelstein test draws the tendons of the first dorsal compartment distally and causes sharp, local pain when tendon entrapment has occurred and inflammation is present. of 2. Tables. Back to List. Contributor Information and Disclosures . Author Roy A Meals, MD Clinical Professor, Department of Orthopedic Surgery, …The Finkelstein test is a simple and reliable method to detect the presence of DeQuevain's disease, a condition that causes pain in the 1st extensor compartment of the wrist. It …A positive test result is recorded if the patient experiences increased pain over the tip of the styloid process. Performing the test in this staged manner is hypothesized to create less false-positive results as it is less provocative than Eichhoff’s Test whch is often confused with the Finkelstein test in the literature. Click on the video ... Sodium Iodide (Finkelstein) Test. A solution of sodium iodide in acetone is a test for some alkyl chlorides and bromides. The mechanism is largely \(S_\text{N}2\), so primary alkyl halides react faster than secondary alkyl halides, and tertiary alkyl halides generally give no reaction. The reaction is driven by the precipitation of the \(\ce ...Fig. 1 Finkelstein's test: the patient's thumb is grasped and the hand abducted ulnarward. Fig. 2 481 Eichhoff's experiment: the thumb is grasped in the clenched fingers and the hand abducted ulnarward. 482 THE JOURNAL OF HAND SURGERY VOL. 17B No. 4 AUGUST 1992 All surgeons should be aware of the correct test so that the …Finkelstein test Pasien disuruh membuat kepalan tangan, dengan cara jempol masuk ke dalam kepalan. Kemudian tangan pemeriksa sebelah kiri memegang antebrachii pasien, tangan kanan pemeriksa menggerakkan wrist ke arah deviasi ulnar. Positif : bila pasien merasakan nyeri.The Finkelstein test is a simple and reliable method to detect the presence of DeQuevain's disease, a condition that causes pain in the 1st extensor compartment of the wrist. It …Nghiệm pháp phalen: tại sao và cơ chế hình thành. Bất kể các nguyên nhân nào gây nên hội chứng ống cổ tay đều làm tăng áp lực trong đường hầm cổ tay. Khi cổ tay bị gấp, các dây chằng vòng hoạt động như một …The Finkelstein test has been described and taught to trainees (orthopedic surgeons, physical therapists, occupational therapists, athletic trainers) several different ways. The most common is the one you tried on yourself. But the test can be very painful and isn’t as specific as needed for an accurate diagnosis.A two-colour multiplexed lateral flow immunoassay system to differentially detect human malaria species on a single test line. Malaria Journal. 2019 Sep 18;18(1):313. PMID: 31533756. ... Finkelstein JL, Aribindi H^, Herman HS^, and Mehta S. Micronutrients and HIV in Pediatric Populations. In Nutrition and HIV: Epidemiological Evidence to Public …El test de Finkelstein es la prueba distintiva para diagnosticar esta patología, aunque no se conocen valores de validez. Por lo tanto, el valor clínico de esta prueba es cuestionable. Para realizar la prueba, Dawson et al. del año 2010 recomiendan un proceso de 3 etapas, que es bien tolerado y capaz de diagnosticar la tendinitis de Quervain ...Aug 11, 2020 · Sodium Iodide (Finkelstein) Test. A solution of sodium iodide in acetone is a test for some alkyl chlorides and bromides. The mechanism is largely \(S_\text{N}2\), so primary alkyl halides react faster than secondary alkyl halides, and tertiary alkyl halides generally give no reaction. Are you preparing to take the Duolingo English Practice Test? If so, you’ll want to make sure you’re as prepared as possible. Here are some top tips to help you get ready for your ...Finkelstein's test. 1. has long been considered to be a pathognomonic sign of this diagnosis and is routinely taught to all trainees involved in musculoskeletal care, in the earliest stages of training. It is imperative that trainees understand that this test can cause considerable discomfort when performed.Sep 21, 2022 · Finkelstein-testen, også kalt Finkelstein-tegnet eller manøver, brukes til å diagnostisere de Quervains tenosynovitt. Dette er en vanlig tilstand preget av hevelse og smerte i to av senene i håndleddet som fester seg til bunnen av tommelen. Eksperter anslag det påvirker omtrent 1,3 % av kvinnene og 0,5 % av mennene. Jan 1, 2005 · The Finkelstein test (Fig. 4),47 performed by adducting and pronating the thumb over the palm, is positive. The basis for this examination was demonstrated by Kutsumi and colleagues,48 where in 15 cadavers the EPB tendon had a greater bulk and tethering effect when the thumb was flexed and adducted in comparison with other tendons, including the APL. Norman Gary Finkelstein ( / ˈfɪŋkəlstiːn / FING-kəl-steen; born December 8, 1953) is an American political scientist and activist. His primary fields of research are the politics of the Holocaust and the Israeli–Palestinian conflict. Finkelstein was born to parents who are both Jewish Holocaust survivors in New York City in 1953. May 20, 2019 · Check out this video to get an understanding of this important test for the wrist joint, to help you diagnose De Quervens Syndrome. It teaches you the method... Jan 1, 2018 · Finkelstein's test. With the thumb flexed across the palm of the hand, ask the patient to move the wrist into flexion and ulnar deviation. This stresses the tendons of abductor pollicis longus and extensor pollicis brevis and reproduces the pain of de Quervain's tenosynovitis. The Finkelstein test is a simple and quick way to diagnose the presence of De Quervain's tenosynovitis, a common cause of wrist pain, by moving the …Jan 1, 2020 ... Finkelstein's test (deviating the wrist to the ulnar side, while grasping the thumb, resulting in pain) is in typical cases positive. In our ...Finkelstein's test produces severe tenderness and usually pain on the radial aspect of the wrist when the thumb is flexed into the palm and the wrist is ulnar deviated. De Quervain's disease is commonly associated with the repetitive motions that place stress on the wrist; it is ommonly associated with professions such as restaurant servers.A Finkelstein test is a simple way to diagnose de Quervain tenosynovitis, a condition that causes thumb pain and swelling. It involves bending your thumb …Published by Elsevier Inc. We have revisited the original description of the Finkelstein test and review the reasons for its subsequent erroneous description. We have also outlined a staged description of this test, which we have found to be reliable and minimally painful for the diagnosis of de Quervain's tendonitis within o ….The Finkelstein test is a simple and quick way to diagnose the presence of De Quervain's tenosynovitis, a common cause of wrist pain, by moving the …This is the original version of the Finkelstein Test which assesses for de quervain's tenosynovitis of the thumb. 🚨 HELP TRANSLATE THIS VIDEO 🚨 If you liked this video, help …Bu testte kişinin başparmağın abduktör ve ekstansör tendonları kontrol edilir. 📌De Quervain Tendiniti başparmağa ait tendonların tekrarlı zorlanmaları ve in...The Finkelstein test draws the tendons of the first dorsal compartment distally and causes sharp, local pain when tendon entrapment has occurred and inflammation is present. of 2. Tables. Back to List. Contributor Information and Disclosures . Author Roy A Meals, MD Clinical Professor, Department of Orthopedic Surgery, …

Definition. Passive Stretching of extensor thumb tendons. III. Indication. De Quervain's Tenosynovitis assessment. IV. Technique: Finkelstein's Test (preferred, higher Test Specificity) Examiner braces wrist in ulnar deviation. Examiner …. Metallica black album

finkelstein test

A technique specifically designed to test for de Quervain’s is called the Finkelstein test. It involves first bending the wrist toward the baby or “pinky” finger, then bending the thumb across the palm. If the test is done correctly, people with the condition will feel pain in the area surrounding the thumb.🎓FREE ONLINE COURSES: https://daniel-lawrence-fc31.mykajabi.com🗞️NEWSLETTER: https://daniel-lawrence-fc31.mykajabi.com/signup📚PUBLISHED BOOKS: https://t.l...Jan 16, 2020 · Test for De Quervain’s Tenosynovitis wrist pain.De Quervain’s Tenosynovitis is inflammation of the synovium or sheath that surrounds two tendons in the wrist... However, Finkelstein's test can also be positive in those suffering from osteoarthritis, so further assessment may be necessary. Who suffers from de Quervain's?The Finkelstein test is used to help diagnose de Quervain's tenosynovitis for patients who are experiencing wrist pain.Finkelstein's test is the classic diagnostic test for de Quervain's disease. Finkelstein hypothesized that the entry of the muscle bellies of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons into the first extensor compartment was responsible for the findings observed in his now eponymous test.The Finkelstein test has been described and taught to trainees (orthopedic surgeons, physical therapists, occupational therapists, athletic trainers) several different ways. The most common is the one you tried on yourself. But the test can be very painful and isn’t as specific as needed for an accurate diagnosis.Finkelstein's test has long been considered to be a pathognomonic sign of this diagnosis, yet most clinicians and instruction manuals erroneously describe what is in fact the Eichhoff's test, which is thought to produce similar pain by tendon stretching in a normal wrist. The purpose of this study was to compare Finkelstein's test with Eichhoff ... Show abstract. December 2020. The spread of COVID-19 has created tremendous challenges to ongoing clinical studies essential to finding effective treatments and cures for a myriad of diseases ...Signs and Symptoms. Finkelstein's Test Pain over the thumb side of the wrist is the primary symptom. This condition may occur “overnight” or very gradually, ...May 27, 2023 · A variation of Finkelstein Test can be used to rule out an incomplete release of previous de Quervain disease. If the usual Finkelstein’s Test is positive, full abduction of the Abductor pollicis longus (APL) followed by flexion of the thumb’s MCP joint will isolate the action of the EPB. Pain with this test will occur if the Extensor ... If the patient's symptoms permit, provocative testing for tendinopathy and ligamentous laxity can be done. The Finkelstein test is done to look for De Quervain syndrome De Quervain Syndrome De Quervain syndrome is stenosing tenosynovitis of the short extensor tendon (extensor pollicis brevis) and long abductor tendon (abductor pollicis longus) of the thumb within the first extensor... .

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