Wrist Hyperflexion Thumb Abduction / WHAT Test | De Quervains tenosynovitis

De Quervains tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. If you have de Quervains tenosynovitis, it will probably hurt when you turn the wrist, grasp anything or make a fist.

Although the exact cause of de Quervains tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.

Symptoms

Symptoms of de Quervains tenosynovitis include:

  • Pain near the base of the thumb
  • Swelling near the base of the thumb
  • Difficulty moving the thumb and wrist when you’re doing something that involves grasping or pinching
  • A “sticking” or “stop-and-go” sensation in the thumb when moving it

If the condition goes too long without treatment, the pain may spread further into the thumb, back into the forearm or both. Pinching, grasping and other movements of the thumb and wrist aggravate the pain.

 

Diagnosis

Imaging tests, such as X-rays, generally aren’t needed to diagnose de Quervains tenosynovitis. Diagnosis of de Quervains tenosynovitis, could be easily accomplished solely by performing physical examination.

Different tests have been described in the past, the most popular test being the Eichhoff’s test, often wrongly named as the Finkelstein’s test.

  • Finkelstein test: the thumb on the affected side is positioned across the palm of the hand and bending fingers down over the thumb. Then the wrist is bent toward the little finger.
    If this causes pain on the thumb side of the wrist, then de Quervains tenosynovitis is likely.

    Originaler Finkelstein-Test
    The classic Finkelstein’s test

 

  • Eichhoff’s test is performed by asking the patient to place their thumb within the hand and clench tightly with the other fingers. The hand is then passively abducted ulnarward by the examiner. The examiner can also perform these maneuvers while palpating the abductor pollicis longus and extensor pollicis brevis tendons over the lateral radius and feeling for moving nodularity, tendon rub, or popping directly over the tendon. Patient is then asked to grade the degree of pain they experienced.
    • According to one study, the 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 greater degree of discomfort than the Finkelstein test in patients.
Finkelstein Test Arrow
An example of a modified Eichoff’s test. Arrow marks where the pain is worsened.
  • The Wrist Hyperflexion Thumb Abduction test, also known as the WHAT test is performed as follows: the wrist is hyperflexed and the thumb abducted in full MP and IP extension, resisted against the therapist’s index finger. Exacerbation of the symptomatology is considered a positive test result.

    Wrist Hyperflexion Thumb Abduction test
    The WHAT test

Treatment

Treatment for de Quervain’s tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.

If treatment is initiated early on, the symptoms should improve within four to six weeks. If de Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.

Medications

  • To reduce pain and swelling, using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) is a good place to start.
  • Injection of corticosteroid medications into the tendon sheath may also be done to reduce swelling if over-the-counter pain relievers are not helpful. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.

Therapy
Initial treatment of de Quervain’s tenosynovitis may include:

  • Thumb and wrist immobilizing, keeping them straight with a splint or brace to help rest the involved tendons
  • Avoiding repetitive thumb movements as much as possible
  • Avoiding pinching with the thumb when moving the wrist from side to side
  • Applying ice to the affected area
  • Physical or occupational therapist. These therapists may review how the wrist is being used and give suggestions on how to make adjustments to relieve stress on the wrists.

Surgery
In more serious cases, outpatient surgery may be recommended. Surgery involves a procedure in which the doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so the tendons can glide freely.

 

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Wrist Hyperflexion Abduction of the Thumb / WHAT Test | De Quervain’s Disease
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This is not medical advice! The content is intended to be educational only for health professionals and students. If you are a patient, seek care of a health care professional.

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