WHAT Test (Wrist Hyperflexion and Abduction): De Quervain Tenosynovitis Guide
In short
Finkelstein and Eichhoff tests often produce false positives in healthy wrists. Learn how the WHAT test (Wrist Hyperflexion and Abduction of the Thumb) delivers superior 99 percent sensitivity for De Quervain tenosynovitis.
In this guide (8 sections)
Limitations of Historical Finkelstein and Eichhoff Tests
For decades, clinicians utilized Eichhoff test (tucking the thumb into a fist and pulling into ulnar deviation), frequently misnaming it Finkelstein test. However, Eichhoff test creates extreme tension across asymptomatic carpal ligaments, producing false-positive results in up to 37 percent of healthy wrists.
The WHAT test (Wrist Hyperflexion and Abduction of the Thumb), introduced by Goubau and colleagues, provides an active dynamic provocation that isolates the first extensor compartment without ligamentous false positives.
How to Perform the WHAT Test Protocol
The patient sits with forearm in neutral and elbow flexed to 90 degrees:
- Wrist Hyperflexion: The patient fully hyperflexes the wrist voluntarily.
- Thumb Abduction against Resistance: While maintaining full wrist hyperflexion, the patient attempts to actively abduct and extend their thumb against the examiner index finger resistance.
- Positive Finding: Exquisite, sharp pain reproduced directly over the radial styloid process at the first extensor compartment confirms De Quervain tenosynovitis.
Anatomical Isolation of APL and EPB Tendons
The first dorsal compartment houses the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) tendons under the extensor retinaculum. Hyperflexing the wrist tightens the retinaculum, while resisted thumb abduction forces the swollen tendons to glide under mechanical compression.
Diagnostic Performance Comparison
| Examination Test | Sensitivity | Specificity | Clinical Advantage | |
|---|---|---|---|---|
| WHAT Test (Goubau) | 99 percent (Near-Perfect) | 96 percent (High) | Zero ligamentous false positives; highly specific | |
| Finkelstein Test (Classic) | 89 percent | 81 percent | Passive ulnar deviation with thumb traction | |
| Eichhoff Test (Thumb in Fist) | 89 percent | 63 percent (Poor) | High false-positive rate in healthy hypermobile wrists |
Frequently Asked Questions
Why is De Quervain tenosynovitis so common in new mothers?
Lifting an infant with hands under the armpits places the wrists in repetitive ulnar deviation and the thumbs in wide abduction, causing severe friction tenosynovitis (colloquially called mommy thumb).
What is a sub-compartment in De Quervain tenosynovitis?
In up to 35 percent of individuals, a congenital fibrous septum divides the first compartment into separate tunnels for the APL and EPB. This anatomical variant often causes conservative steroid injections to fail if only one tunnel is infiltrated.
First Dorsal Compartment Anatomy and Septa Variations
The first dorsal extensor compartment houses the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. In up to 35 percent of individuals, a congenital fibrous septum divides the compartment into two separate sub-tunnels. This anatomical anomaly frequently causes conservative corticosteroid injections to fail if only one tunnel is infiltrated.
Progressive Tendon Loading and Splinting
Therapy utilizes a forearm-based thumb spica splint during acute flare-ups, followed by progressive isometric thumb abduction against resistance bands. Eccentric radial and ulnar deviation drills condition the tendon to tolerate repetitive wrist handling.
New Mothers and Kitchen Handling in India
Often called baby wrist, lifting newborn infants with outstretched thumbs and holding heavy cooking vessels (kadhais and pressure cookers) by single-handed handles place excessive shear across the radial styloid. Scooping infants with forearms and using two-handed vessel grips prevents chronic tenosynovitis.
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