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Volume VI, Number 1 | March 2022

Tips of the Trade: The Diagnosis of De Quervain’s Tenosynovitis

Editor’s Note: “The Paksima Sign“.  The honor of featured article is given to Neil Gambhir and Dr. Nader Paksima for their original work on a well-known condition.  Dr. Paksima, a tireless educator and strong supporter of the AOAO, along with Neil Gambhir are to be congratulated!

By Neil Gambhir BS and Nader Paksima, DO

First described by Dr.  Fritz de Quervain in 1895, De Quervain Tenosynovitis is one of the most common pathologies that hand surgeons encounter today. The condition is characterized by thickening of the tendons within the first dorsal compartment of the hand, namely the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB)1. The function of the APL is primarily extension of the thumb metacarpal (not abduction) and the EPB’s function is extension of the MP joint. Patients with De Quervain’s experience pain throughout the radial aspect of their wrist that is worsened by thumb and wrist movement. This condition is classically seen in new mothers and in those who frequently text message2.

Figure 1: Heathy hand with thumb abduction
Figure 2: Hand with De Quervain Tenosynovitis, concomitant adduction and extension are seen

Diagnosis is made clinically via the Finklestein test which involves the examiner inducing ulnar deviation of the wrist while the thumb is flexed into the palm on the affected side, thereby pulling the tendons of the APL and EPB through the tight sheath. The reproduction of pain is considered a positive test and is pathognomonic of the presence of De Quervain Tenosynovitis3.

Through clinical examination, we have observed a physical exam finding that may aid in the diagnosis of De Quervain’s Tenosynovitis. We have observed that patients afflicted with this tenosynovitis markedly adduct their thumb upon attempted extension (Figure 2). We postulate that this abnormal motion of the thumb occurs due to the use of the EPL to extend the thumb metacarpal instead of the APL. The EPL has an adduction moment and so the thumb extends and adducts. Patient will avoid activating the APL and EPB to extend the thumb due to pain. In effect, this is the opposite action of the Finkelstein test. This maneuver may help make the diagnosis of De Quervain’s tenosynovitis in patients who are unable to complete the Finklestein test or who have an unclear presentation.


  1.  Allbrook V. ‘The side of my wrist hurts’: De Quervain’s tenosynovitis. Aust J Gen Pract. 2019 Nov;48(11):753-756. doi: 10.31128/AJGP-07-19-5018. PMID: 31722458.
  2. Ali M, Asim M, Danish SH, Ahmad F, Iqbal A, Hasan SD. Frequency of De Quervain’s tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons J. 2014;4(1):74–78. Published 2014 May 8.
  3. Som A, Singh P. Finkelstein Sign. [Updated 2019 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
The Journal of the American Osteopathic Academy of Orthopedics

Steven J. Heithoff, DO, FAOAO

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Authors in This Edition

J. Michael Anderson BS, OMS IV
Rigel Bacani BA, BS, OMS II
David Beckett OMS I
Bhakti Chavan MBBS, MPH
Jake Checketts DO
Grant Chudik OMS II
Adam Dann
Marc Davidson MD
Clinton J. Devin MD
Jeffrey Dulik DO
Bryan Dunford BS, OMS II
Diego Galindo DO
Gregory Galvin DO
Curtis Goltz DO

Jordan Grilliot DO
Brian Handal
Safet Hatic
Scott Dean Hodges DO
David Houserman DO
Jenna Jarrell MS IV
Michael Jones DO
Anthony Kamson DO
Tyler Metcalf MS IV
Anna Elisa Muzio DO
Cesar Cornejo Ochoa OMS I
Brandi Palmer MS
Joseph Patrick
David Phillips DO

Jonathan Phillips MD
Kornelis Poelstra MD
Jesse Raszewski DO, MS
Katherine Sage DO
Steven Santanello DO, FAOAO
Jared Scott DO
Julieanne Sees
James Seymour DO
Jonathan Schneider DO
John Alex Sielatycki MD
Benjamin Taylor MD, FAAOS
Trevor Torgerson BS, OMS IV
Phong Truong DO
Matt Vassar PhD