The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test

Abstract

De Quervain's disease has different clinical features. 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. Over the years, a misinterpretation has occurred between these two tests, the latter being confused with the first. To compare the Eichhoff's test with a new test, the wrist hyperflexion and abduction of the thumb test, we set up a prospective study over a period of three years for a cohort of 100 patients (88 women, 12 men) presenting spontaneous pain over the radial side of the styloid of the radius (de Quervain tendinopathy). The purpose of the study was to compare the accuracy of the Eichhoff's test and wrist hyperflexion and abduction of the thumb test to diagnose correctly de Quervain's disease by comparing clinical findings using those tests with the results on ultrasound. The wrist hyperflexion and abduction of the thumb test revealed greater sensitivity (0.99) and an improved specificity (0.29) together with a slightly better positive predictive value (0.95) and an improved negative predictive value (0.67). Moreover, the study showed us that the wrist hyperflexion and abduction of the thumb test is very valuable in diagnosing dynamic instability after successful decompression of the first extensor compartment. Our results support that the wrist hyperflexion and abduction of the thumb test is a more precise tool for the diagnosis of de Quervain's disease than the Eichhoff's test and thus could be adopted to guide clinical diagnosis in the early stages of de Quervain's tendinopathy.

Examination of the Wrist: Radial-Sided Wrist Pain

“…With a sensitivity of 0.99 and specificity of 0.29 this test may allow the clinician to more accurately diagnose de Quervain disorder than using the Eichhoff test alone (sensitivity 0.89, specificity 0.14). 6 Intersection syndrome presents with pain, swelling, and crepitus on the radial side of the wrist where the muscle bellies of abductor pollicis longus and extensor pollicis brevis, respectively, cross over the tendons of extensor carpi radialis longus and brevis. Alternatively, this condition is thought to be due to entrapment of the second extensor compartment.…”

“…6 With the wrist maximally flexed, the patient is asked to abduct their thumb against resistance by the examiner (Fig. 4).…”

Diagnosis and management of intersection syndrome as a cause of overuse wrist pain

“…Finkelstein's is commonly negative in intersection syndrome, though Eichoff's test may produce false positives 9 15…”

“…Finkelstein's test is confirmatory because it has good specificity and sensitivity 20. Though Eichoff's test is also positive in de Quervain's, it often produces a false-positive result 15. It is more common in women aged between 30 and 50 years and has been widely reported in new mothers carrying their children 19 21 Figure 3.…”

Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results

“…This test is known as the wrist hyperflexion and abduction of the thumb (WHAT) test. 20 The peak palmar movement of the tendons was measured in millimeters of motion of the tip of the radial styloid. Both sides were compared.…”