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Background: The growing prevalence of smartphone use among college students in China has led to health concerns, including De Quervain's Tenosynovitis (DQT). However, the specific smartphone usage behaviors contributing to DQT remain poorly understood. This study aimed to explore the relationship between smartphone usage behaviors and DQT in college students. Methods: A cross-sectional study was conducted with 937 students from various majors in Guangxi between September 2021 and April 2022. Participants completed an online questionnaire assessing smartphone usage behaviors and their association with DQT. The Finkelstein test was employed to diagnose DQT. Results: Over half of the college students (52%) tested positive for DQT via Finkelstein's test. Higher levels of smartphone usage time (6–8 h/day: OR = 4.454, 95%CI:1.662–12.229; ≥8 h/day: OR = 4.521, 95%CI:1.596–12.811), phone games (OR = 1.997, 95%CI:1.312–3.040), social media (OR = 2.263, 95%CI:1.795–3.833), and leisure activities (OR = 1.679, 95%CI:1.140–2.475) were significantly associated with an increased risk of DQT. Two specific gestures (Bilateral thumbs, BT: OR = 1.900, 95%CI:1.281–2.817; Bilateral thumbs-horizontal screen, BT-HS: OR = 1.872, 95%CI:1.244–2.818) and two screen sizes (5.0-5.5inch: OR = 2.064, 95%CI:1.108–3.846; 6.0-6.5inch: OR = 2.413, 95%CI:1.125–4.083) also exhibited a higher risk of DQT. Bilateral DQT was observed, with Gesture-BT identified as the primary risk factor. Conclusion: Our findings suggest that increased smartphone usage time, phone games, social media, and leisure activities elevate the risk of DQT among college students. Furthermore, two specific gestures and two screen sizes were also linked to a heightened DQT risk. To mitigate DQT development, college students should reduce smartphone usage time and adopt appropriate gestures. [ABSTRACT FROM AUTHOR]