De Quervain's tenosynovitis

Also known as de Quervain's tendonosis

Key points about de Quervain's tenosynovitis

De Quervain’s tenosynovitis is a painful hand condition affecting the tendons you use to straighten your thumb. Tendons are strong cords that connect muscles to bones.
The condition develops when the tendons around the base of your thumb become irritated from increased use.
If it's mild, self-care measures may ease the pain, and you can recover within a few weeks.
It’s a good idea to seek help if de Quervain's is not settling with a few days of reduced use. If not, it could become a long-term problem.

Woman in pink tee-shirt holding painful wrist or hand

De Quervain’s tenosynovitis is a tendon problem at the base of the thumb. It happens when the sheath that the tendons slide through becomes swollen and thickened, probably from tendon use increasing more quickly than the tendons can adapt. The thickening can make it uncomfortable for the tendons to glide through the sheath. Tendons can become blocked from sliding or ‘lock’. One or both wrists can be affected.

De Quervain's tenosynovitis with an inflamed tendon sheath

Image credit: Depositphotos

The main symptoms are pain and swelling at the base of your thumb or at your wrist. You may find it painful to turn your wrist, grip or grasp anything, or make a fist. It tends to get worse when you use it and gets better when you rest it.

It’s important that you get advice and treatment for it. If your tendon use continues at same level, the tendons can become very sensitive and take a long time to settle.

De Quervain’s tenosynovitis develops when the load on the thumb tendons increases more quickly than the tendons can adapt. This may happen with movement, such as those used when gardening, playing golf, hammering nails or lifting your baby. This causes swelling of the sheath that tendons in your wrist pass through, which stops them moving freely. The thickening gets worse if you keep doing these or similar activities.

Parents or caregivers of young children are at increased risk of developing de Quervain’s tenosynovitis due to increased lifting as the child is also getting heavier.

The main symptoms are pain and swelling at the base of your thumb or at your wrist.

The pain is worse when you’re using your hand and thumb – particularly when you raise your thumb as if you were hitching a ride.
It may be sharp or dull, and 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.
It can also catch or make a graunching sound as you move your thumb and wrist.

Your healthcare provider or physiotherapist will be able to make a diagnosis by examining your wrist and assessing its movements. An X-ray isn't needed for diagnosis but may be useful if it’s possible that there's another cause for your symptoms, such as osteoarthritis.

If your symptoms aren't settling, an ultrasound scan may be used to confirm the diagnosis of De Quervain's.

The type of treatment depends on how bad your symptoms are.

Mild symptoms

If your symptoms are mild there are a few things you can try to ease the pain and help your wrist to recover.

These include:

using your wrist and thumb less
wearing a splint at night
taking non-steroidal anti-inflammatory medicines such as ibuprofen (if you are able to) for the pain
physiotherapy or hand therapy for:
- advice on how to reduce how hard your tendons are working
- exercises to help the tendon move more smoothly through the sheath and build load capacity to get back to normal.

More severe symptoms

If these steps don’t resolve the problem, then your healthcare provider may recommend corticosteroid injections into the tendon sheath. This works for about 80% of people (8 in 10). An injection may be combined with a splint that you wear for most of the day.

Surgery

If these less-invasive options haven’t 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 (a nerve block) and takes about 30 minutes. Recovery after surgery can take 4 to 6 months.

A hand therapist can help with treatments, including exercises and wrist splints, and can give you advice about returning to work and what to do at work.

Use your wrist and thumb less.
Avoid moving your wrist and thumb the same way repeatedly.
Change the way you do repeated movements, such as lifting your children in a different way.
Wear a wrist and thumb splint.
Apply hot or cold packs to your wrist.
Take pain relief.
Slide the tendon through the tunnel by unloaded thumb movements once the pain starts to settle.

Find out more about thumb exercises for De Quervain's(external link). Note that it's best to start with the first exercise (thumb lifts). Don't move on to the next one until this is comfortable. When you are ready to progress to the next exercise, start with a few repetitions to see how it affects your symptoms. If your symptoms flare, go back to the previous exercise for a few more days before trying to progress again.

The image below shows somebody wearing a wrist and thumb splint.

Image credit: Depositphotos

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Tennis elbow
Arthritis – an introduction
Hand and wrist conditions

The following links provide further information about de Quervain’s tenosynovitis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

de Quervain's tenosynovitis(external link) Health New Zealand | Te Whatu Ora, NZ
de Quervains tendinosis(external link) OrthoInfo, US