Hand iSAWE 10

Question

A 34 year old woman, eight weeks post partum, has radial sided wrist pain when lifting her baby. The manoeuvre shown reproduces her pain.

Hand iSAWE 10, clinical photograph of the wrist
Clinical photograph of the wrist. Image by InvictaHOG, Wikimedia Commons, Public domain.
  1. What is the test and the diagnosis?
  2. Describe the relevant anatomy and its surgical significance.
  3. How would you manage her?

Answer

Test and diagnosis

  • Finkelstein test (Eichhoff manoeuvre as commonly performed), ulnar deviation with the thumb flexed in the palm
  • De Quervain stenosing tenosynovitis of the first extensor compartment

Anatomy

  • First compartment holds abductor pollicis longus and extensor pollicis brevis
  • APL often has several slips
  • Separate EPB subcompartment with its own septum in many wrists
  • Failure to release the EPB subcompartment causes persistent symptoms
  • Superficial radial nerve branches cross the compartment

Differential diagnosis

  • Thumb CMC arthritis (grind test)
  • Intersection syndrome, more proximal
  • Superficial radial neuritis (Wartenberg)
  • Scaphoid pathology

Management

  • Thumb spica splint and activity change
  • Corticosteroid injection into the sheath, about 70% respond to one or two injections
  • Post partum symptoms often settle after weaning
  • Surgical release through a transverse or longitudinal incision
  • Protect superficial radial nerve branches
  • Release the EPB subcompartment
  • Release the dorsal side of the sheath to avoid volar tendon subluxation

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.