Abstract

Objectives: Hand maneuvers commonly used to clinically diagnose De Quervain tenosynovitis (DQT) possess differing intrinsic levels of discomfort. We hypothesized that assessing the degree of pain would better differentiate replication of condition-related pain than a binary “yes or no” assessment, and we hope to use these data to establish thresholds on a Likert pain scale for these tests to designate a positive or negative result. Attempting to minimize false positives associated with a binary positive or negative result may result in the reduction of delayed or inappropriate management.

Methods: Forty-three adult patients were administered four provocative hand maneuvers classically used for clinical DQT diagnosis—Eichhoff test (ET), Finkelstein test (FT), the wrist hyperflexion and abduction of the thumb test (WHATT), and the radial synergy test (RST)—as well as an experimental maneuver, the first dorsal compartment test (FDCT). Qualified personnel performed each of these tests on both hands of all of the participants. Participants were asked whether each maneuver elicited pain to assess a binary positive or negative result. If positive, then participants were asked to give a 1 to 10 pain rating. Negative results were assigned a pain rating of 0. Participants were divided into two groups based on the relation of their visit diagnosis to the hand or wrist. The χ2 tests and Fisher exact tests were used to compare binary results. Paired t tests and analysis of variance were used for patient-reported pain rating comparison. Significance was determined using P < 0.05 for all of the tests.

Results: A significant difference was found in binary pain results between tests in both the dominant and nondominant hands, with ET showing the highest rate of positive response. Only FT and WHATT, however, were found to have a significantly higher rate of positive response in the dominant hand among the hand diagnosis group. No statistically significant findings were discovered in the nondominant hand between those with and without hand diagnoses. A significant difference between self-reported pain intensity also was found between tests in the dominant hand among the entire cohort. Similar to the binary results, ET demonstrated a significantly higher mean pain rating than FT, RST, and FDCT in the dominant hand across the entire cohort. This was maintained in the nondominant hand for RST and FDCT. Those with a hand-related diagnosis reported significantly increased levels of pain in their dominant hand due to ET, FT, and WHATT compared with those without a hand-related diagnosis. Of the 22 participants with a hand-related complaint, only two had a diagnosis of DQT during their visit. For each test with a positive result in these patients, the respective Likert score was 8 or higher.

Conclusions: The current analysis calls for implementation of a pain rating threshold for DQT diagnosis using ET, and analysis specific to DQT patients supports establishing thresholds for each test studied. Continued prospective research should be done to further specify these thresholds for a gold standard of DQT diagnosis, however.