De Quervain’s Tenosynovitis: Symptoms and Treatment

01What

What is De Quervain’s tenosynovitis?

Two tendons that move the thumb, the abductor pollicis longus and extensor pollicis brevis, pass through a narrow tunnel (the first dorsal compartment) on the thumb side of the wrist. When the tendon sheath thickens and the tendons rub, they become painful and swollen. It is often called “mommy’s thumb” or “gamer’s thumb” because of common triggers. See hand tendonitis, dolor de muñeca (Spanish) and tendonitis.

02Symptoms

Symptoms

• Pain on the thumb side of the wrist, along the base of the thumb and sometimes up the forearm.
• Swelling or a tender lump over the thumb side of the wrist.
• Pain when gripping, pinching, twisting (opening jars, wringing a cloth) or turning a key.
• Pain when moving the thumb or bending the wrist toward the little finger.
• A catching, snapping or “sticking” sensation in the thumb.
• Numbness or tingling over the back of the thumb and index finger, if the nearby radial sensory nerve is irritated (Wartenberg’s syndrome).
• Difficulty lifting or holding a baby, using a phone or playing video games.

03Causes

Causes and risk factors

• Repetitive thumb and wrist movements: texting, gaming, typing, using a mouse, knitting, gardening, golf and racquet sports.
• Lifting babies, with the wrist in a bent position, particularly in the first months after birth.
• Pregnancy and breastfeeding, related to hormonal changes and fluid retention.
• Age 30–50 and female sex.
• Wrist injury or direct trauma.
• Inflammatory arthritis, such as rheumatoid arthritis.
• It is not caused by one single activity but by overload relative to tendon capacity.

04Test

How it is diagnosed

• Finkelstein’s test: make a fist with the thumb tucked inside the fingers and tilt the wrist toward the little finger; sharp pain over the thumb side of the wrist suggests De Quervain’s. A clinician does this carefully.
• Palpation of the first dorsal compartment for tenderness and swelling.
• Exclusion of thumb-base arthritis (carpometacarpal osteoarthritis), scaphoid fracture, intersection syndrome and nerve irritation.
• X-rays rule out arthritis or fractures; ultrasound can show tendon sheath thickening.
• Diagnosis is clinical in most cases.

05Splint

Splint, rest and pain relief

• Thumb spica splint that immobilises the thumb and wrist for 4–6 weeks, worn most of the day and night, then weaned.
• Avoid aggravating movements such as repetitive gripping, pinching and twisting.
• Modify tasks: lift your baby with both palms rather than with the thumbs spread, use voice typing, hold phones and tablets with both hands or a stand.
• Ice for 10–15 minutes after activity; heat if stiff.
• Anti-inflammatory tablets or topical gel in short courses, if suitable.
• Ergonomic changes: a vertical mouse, larger grip tools, short breaks.
• Many mild cases settle with these measures over 4–8 weeks.

06Exercise

Hand therapy and gentle exercises

• Gentle tendon gliding: with the splint off, slowly move the thumb across the palm and back, 10 repetitions several times a day, only within comfort.
• Thumb and wrist range of motion exercises once pain eases.
• Light isometric thumb exercises and gradually progressive grip strengthening.
• Forearm stretches for the thumb and wrist.
• Avoid forceful stretching into the painful position in the early stage.
• A hand therapist can fit a custom splint and guide progression.

07Medical

Injections and surgery

• Corticosteroid injection into the tendon sheath relieves symptoms in roughly 70–90% of people; it works best for early cases, and a second injection may be needed.
• Injection risks include temporary skin lightening or thinning at the site and, rarely, tendon problems; ultrasound guidance improves accuracy.
• Surgical release of the first dorsal compartment under local anaesthesia, for symptoms that do not respond to splinting and injections after several months.
• Recovery after surgery: a few weeks for normal use; scar tenderness and nerve irritation are possible.
• In new mothers, symptoms often resolve when the baby is lighter and weaned.

09Cases

Three common situations

A new mother with wrist pain when lifting her baby: a thumb spica splint, a neutral wrist hold technique and rest; injection if needed.

A gamer or heavy phone user with thumb-side pain: take breaks, use two hands and wear a splint during flare-ups.

A person with pain after a fall onto the hand: need an X-ray to exclude a scaphoid fracture.

10Summary

Key points to remember

De Quervain’s tenosynovitis causes thumb-side wrist pain, usually from overuse. A thumb splint, task changes and hand therapy help, and an injection works for many. See a clinician for persistent pain or injury. Our physiotherapy team can plan your treatment.

This guide is for general information and does not replace an assessment by your own doctor or physiotherapist.