De Quervain's tenosynovitis

• De Quervain’s tenosynovitis develops when the tendons around the base of your thumb become irritated or constricted from overuse.
• The main symptom is pain and swelling at the base of your thumb or at your wrist.
• The pain is noticeable when you turn your wrist, grip or grasp anything or make a fist. It is made worse with activity and eased by rest. 
• In mild cases, self-care measures such as resting your wrist and thumb, wearing a splint at night, physiotherapy and anti-inflammatory medication may ease the pain and you can recover within a few weeks. 
• It’s essential that you treat de Quervain’s. If left untreated, it can cause permanent damage to the movement of your wrist and thumb or cause the tendon sheath to burst.

Although the exact cause of de Quervain's tenosynovitis isn't known, it is believed to be associated with overuse due to repeated hand or wrist movements, such as those used when gardening, playing golf, hammering nails or lifting your baby. This causes swelling of the tendons in your wrist. The inflammation gets worse if you keep doing these or similar functional activities.

Parents or caregivers of young children are at increased risk of developing de Quervain’s tenosynovitis due to repetitive lifting that force the wrist into a position that puts strain on the tendon. 

The main symptom is pain and swelling at the base of your thumb or at your wrist.

• The pain is worse when your hand and thumb are in use.
• It may be sharp or dull, and it may appear gradually or suddenly.
• The pain can be felt all the way up your forearm.
• There may be swelling over the thumb side of your wrist, sometimes together with a fluid-filled sac in that area.
• You may have difficulty moving your thumb and wrist area because of pain and swelling.

Your doctor or physiotherapist will be able to make a diagnosis based on an examination of your wrist and an assessment of its movements. An X-ray is not necessary for diagnosis but may be useful if it’s possible that there is another cause for your symptoms, such as osteoarthritis.

Treatment differs based on how severe your symptoms are. 

• If your symptoms are mild, resting your wrist and thumb, wearing a splint at night, physiotherapy and anti-inflammatory medication (nonsteroidal anti-inflammatory drugs such as ibuprofen) may ease the pain. Following these steps, milder cases can recover within a few weeks. 
• If these steps do not resolve the issue, then your doctor may recommend corticosteroid injections into the joint. This is effective in 8 out of 10 people.
• In some cases, therapeutic ultrasound may be offered.
• You could also consider acupuncture as an alternative option for treatment as it has been found to have some success in relieving symptoms.
• If these less-invasive options have not provided relief, surgery to open the tunnel and make more room for the tendons may be considered. The operation can usually be performed under local anaesthetic and usually takes about 30 minutes. Recovery after surgery can take 4 to 6 months.
• A private hand therapist can help with treatments, including exercises and wrist splints, and occupational advice.

• Rest your hand as much as possible.
• Wear a hand splint.
• Avoid moving your wrist and thumb the same way repeatedly.
• Modify your activities, for example, lift your children in a different way.
• Do exercises(external link)(external link) to strengthen the area.
• Apply hot or cold packs to your wrist.
• Take pain relief.

Clinical resources

Patients with this disorder should always receive instructions in combination with another form of treatment, such as nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery. Huisstede BM, Coert JH, Fridén J, Hoogvliet P. Consensus on a multidisciplinary treatment guideline for de Quervain disease – results from the European HANDGUIDE study(external link). Phys Ther. 2014 Aug;94(8):1095-110.

Goel R, Abzug JM. de Quervain's tenosynovitis – a review of the rehabilitative options(external link). Hand. 2015 Mar;10(1):1-5. 

Steroid injection is an effective form of conservative management for de Quervain's disease. See Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults(external link). Eur J Orthop Surg Traumatol. 2014 Feb;24(2):149-57. 

Continuing professional development

Video: Hand injection techniques

This video may take a few moments to load.

(Dr Stuart Myers, Australia, 2011)