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Self-Reported Pain Rating during Clinical Testing and De Quervain Tenosynovitis.

Gregory R Vance1, Clay B Thames1, Evan C Bowen1

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Summary

Assessing pain intensity, not just a yes/no response, better diagnoses De Quervain tenosynovitis (DQT). Establishing pain rating thresholds for diagnostic tests can improve accuracy and patient management.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Diagnostic Accuracy

Background:

  • De Quervain tenosynovitis (DQT) is commonly diagnosed using provocative hand maneuvers.
  • Current binary (yes/no) pain assessments may lead to false positives and suboptimal patient management.
  • Differing pain levels elicited by diagnostic tests suggest potential for improved diagnostic differentiation.

Purpose of the Study:

  • To evaluate if pain intensity ratings offer better diagnostic differentiation for DQT than binary assessments.
  • To establish potential Likert scale pain thresholds for DQT diagnostic tests.
  • To minimize false positives and improve the timeliness and appropriateness of DQT management.

Main Methods:

  • Forty-three patients underwent five provocative hand maneuvers: Eichhoff test (ET), Finkelstein test (FT), wrist hyperflexion and abduction of the thumb test (WHATT), radial synergy test (RST), and first dorsal compartment test (FDCT).
  • Participants provided binary pain responses (yes/no) and, if positive, a 1-10 pain rating (0 for negative).
  • Statistical analyses included chi-squared, Fisher exact, paired t-tests, and ANOVA (P < 0.05 significance).

Main Results:

  • Significant differences in binary pain results were observed across tests for both dominant and nondominant hands, with ET showing the highest positive rate.
  • The Eichhoff test (ET) demonstrated significantly higher mean pain ratings compared to FT, RST, and FDCT in the dominant hand.
  • Patients with hand-related diagnoses reported significantly higher pain levels for ET, FT, and WHATT in their dominant hand; positive results in DQT patients consistently yielded Likert scores of 8 or higher.

Conclusions:

  • Implementation of pain rating thresholds for diagnostic tests, particularly the Eichhoff test (ET), is recommended for De Quervain tenosynovitis (DQT) diagnosis.
  • Analysis specific to DQT patients suggests establishing thresholds for each tested maneuver.
  • Further prospective research is needed to refine these thresholds and establish a gold standard for DQT diagnosis.