WHAT Test

What is de Quervain's disease?

De Quervain’s disease, also known as de Quervain’s tenosynovitis, is a painful condition affecting the tendons on the thumb side of your wrist. The condition occurs when the tendons that control thumb movement — primarily the abductor pollicis longus (AbPL) and extensor pollicis brevis (EPB) — become inflamed. These tendons reside in the first extensor compartment, which is significant for diagnosing De Quervain’s disease. This inflammation can cause pain, swelling, and difficulty moving the radial side of the thumb and wrist, especially when grasping or pinching objects.

De Quervain’s disease is often associated with repetitive hand or wrist movements, such as those involved in gardening, playing sports, lifting babies, or typing. It is a common condition among individuals who engage in activities that require repetitive thumb motions, but it can also occur without any apparent cause. De Quervain’s disease is one of several wrist injuries that can result from repetitive strain or trauma.

Symptoms

The symptoms of De Quervain's disease can vary in severity, but typically include:

• Pain near the base of the thumb
• Swelling near the base of the thumb
• Difficulty moving the thumb and wrist when performing activities that involve grasping or pinching
• A "sticking" or "stop-and-go" sensation in the thumb when moving it
• Pain that may radiate up the forearm

De Quervain's disease has very similar symptoms to wrist sprains. However, what makes it different from a sprained wrist is that thumb motions (like gripping and lifting) are more painful with de Quervain's disease and can trigger a catching or snapping sensation.

Causes

De Quervain’s disease is commonly caused by activities or conditions that involve repetitive wrist and thumb motions, such as:

• Repetitive strain or overuse of the wrist and thumb
• Hobbies that require repetitive hand movements
• Direct injury to the wrist or tendons, including a wrist sprain
• Conditions such as rheumatoid arthritis
• Pregnancy and postpartum hormones

De Quervain's tenosynovitis is known as "new mother's thumb" because of its relation to pregnancy and postpartum hormones. It has come to be known as "gamer's thumb" or "texter's thumb" in recent times.

What is the WHAT Test?

The Wrist Hyperflexion and Abduction of the Thumb Test is a diagnostic tool specifically involving de Quervain’s tenosynovitis, a condition that affects the thumb’s tendons. This test is one of several used to diagnose de Quervain’s tenosynovitis. It is an active assessment involving the patient’s active participation, which helps isolate the abductor pollicis longus and extensor pollicis brevis tendons. Unlike other tests like Finkelstein’s Test, the WHAT Test minimizes the involvement of other joints and structures, thereby reducing the likelihood of false positives.

During the test, the patient is asked to hyperflex their wrist while extending their thumb and abducting. The examiner then applies resistance to the thumb’s abduction. If the patient experiences pain during this resisted movement, the test is considered positive, indicating the presence of de Quervain’s tenosynovitis. This pain arises from the shear stress on the tendons involved in the condition, which is exacerbated during the test.

Studies have shown the effectiveness of the WHAT Test by comparing clinical findings with other diagnostic methods. The WHAT Test was developed as a more specific and sensitive alternative to other diagnostic tests for De Quervain’s disease. Goubau et al. (2013), the developers of this test, report that it has a high sensitivity rate, making it a reliable tool for ruling out the condition, although its specificity is lower than that of most popular tests.

The WHAT Test can guide clinical diagnosis by providing a more accurate assessment. Additionally, the WHAT Test has shown an improved negative predictive value compared to traditional tests like Eichhoff’s Test.

How to use our WHAT Test template

Our WHAT Test template is designed to streamline the process of diagnosing De Quervain's Tenosynovitis. To ensure accurate results and consistent documentation, follow these simple steps:

Step 1: Download our template

Access the WHAT Test template by clicking Use Template. This template is designed to guide you through each step of the process, ensuring nothing is overlooked.

Step 2: Complete patient information

Begin by filling in the patient's details, including their name, age, and relevant medical history. Accurate information here is crucial for the test's context and future reference.

Step 3: Conduct the test

Follow the steps outlined in the test procedure section of the template. This includes asking the patient to hyperflex their wrist and resist thumb joint abduction while you apply pressure.

Step 4: Record the results

After completing the test, use the checklist provided in the template to indicate whether the test was positive or negative. Include any additional notes or observations that may be relevant to the diagnosis.

Benefits of using our template

Our WHAT Test template offers several key benefits that enhance your diagnostic process's efficiency and accuracy.

Standardized documentation

Our template ensures that all critical information is consistently documented across different patients and sessions. This standardization reduces the likelihood of missing important details and enhances the reliability of your diagnostic records.

Improved patient communication

The template is designed to be user-friendly, making it easier to explain the test procedure and results to your patients. Clear communication helps patients understand their condition and the steps you are taking to diagnose and treat it.

Time-saving tool

Our template provides a structured format, helping you conduct the WHAT Test more efficiently. The predefined fields and checklists streamline the process, allowing you to focus more on patient care than administrative tasks.

Reference

Goubau, J. F., Goubau, L., Van Tongel, A., Van Hoonacker, P., Kerckhove, D., & Berghs, B. (2013). 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. Journal of Hand Surgery (European Volume), 39(3), 286–292. https://doi.org/10.1177/1753193412475043