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Wrist Hyperflexion and Abduction of the Thumb (WHAT) Test

Original Editor - Trista Chan
Top Contributors - Trista Chan, Peace Samuel and Carina Therese Magtibay


Purpose

De Quervain's Tenosynovitis is a condition involving the abductor pollicis longus (AbPL) and extensor pollicis brevis (EPB) tendons in the first extensor compartment of the wrist[1]. Different tests has been used to identify De Quervain's disease, with the Finkelstein's test being one of the common diagnostic tests[2].

The Finkelstein's test is often confused with the Eichhoff's test[2][3], thus the Wrist hyperflexion & Abduction of the Thumb test is developed in 2014 as an alternative test for De Quervain's disease[3]. The WHAT test being an active test, it better isolates the AbPL & EPB tendons and eliminates the excursion mechanism of the tendons[3].

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Technique

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Procedure:

  1. The patient is seated in a comfortable position.
  2. They are asked to actively hyperflex their wrist and abduct their thumb.
  3. The examiner then resists the movement with their index finger.[3]

Interpretation:

Pain reproduction indicates a positive test for De Quervain's Tenosynovitis [3]

Evidence

A study found that The WHAT test is more accurate as compared to traditional diagnostic test for De Quervain's, with a sensitivity score of 0.99 and specificity score of 0.29 [3]. However, the study involved a small sample size and only two experienced surgeons. Therefore, further investigations need to be done to confirm the reliability and validity of the test [3].

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References

  1. ↑ Satteson E, Tannan SC. De Quervain tenosynovitis.
  2. ↑ 2.0 2.1 Wu F, Rajpura A, Sandher D. Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease. Journal of hand and microsurgery. 2018 Aug
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Goubau, J.F., Goubau, L.A.U.R.E.N.T., Van Tongel, A., Van Hoonacker, P., Kerckhove, D. and Berghs, B., 2014. 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)
  4. ↑ www.youtube.com. (n.d.). Wrist Hyperflexion Abduction of the Thumb / WHAT Test | De Quervain’s Disease. [online] Available at: https://www.youtube.com/watch?v=RnBY8sSDoR0
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