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De Quervains Tenosynovitis (Thumb Tendinitis)

De Quervain tenosynovitis is an excruciating condition that affects the tendons on the thumb part of the wrist. It often causes discomfort when turning the wrist, gripping objects or making a fist.

While the exact cause is unclear, repeated wrist or hand movements—such as gardening, playing racket or golf sports, or carrying a baby—can aggravate the condition.

Symptoms

Common symptoms associated with de Quervain tenosynovitis comprise:

  • Pain and swelling around the base of the thumb
  • Trouble moving the wrist or thumb, especially when grasping or pinching
  • A “sticking” or “stop-and-go” feeling when moving the thumb

If left untreated, the pain may extend into the thumb, forearm or both, and movement of the thumb and wrist can worsen the discomfort.

Causes

De Quervain tenosynovitis usually strikes two tendons on the wrist’s thumb side. These tendons, which are rope-like structures connecting muscle to bone, can become irritated with repeated hand movements over time.

Chronic overuse (like performing the same hand motion daily) can inflame the protective covering near the tendons. This inflammation may cause the tendons to thicken and swell, hence restricting their movement through the narrow tunnel that links them to the base of the thumb.

Other potential causes of de Quervain tenosynovitis are:

  • Inflammatory arthritis, like rheumatoid arthritis
  • Direct wrist or tendon injury that can lead to scar tissue limiting tendon movement
  • Fluid retention, often due to hormonal changes during pregnancy

Risk Factors

Several factors can increase the risk of developing de Quervain tenosynovitis:

  • Age: Individuals between 30 and 50 are more likely to develop the condition than those in other age groups, like children.
  • Gender: Women are more commonly affected than men.
  • Pregnancy: Hormonal changes during pregnancy may contribute to the condition.
  • Baby care: Frequently carrying a child, which usually involves the use of the thumbs for support, may increase the risk.
  • Repeated hand and wrist movements: Jobs or hobbies that require constant hand or wrist motion can contribute to the development of de Quervain tenosynovitis.

Diagnosis

Diagnosing de Quervain tenosynovitis involves an examination of your hand as well as checking for pain by applying pressure to the thumb side of the wrist.

Diagnostic tests:

  • Finkelstein test: You will be asked to bend your thumb transversely to your palm, cover it with your fingers then bend your wrist toward the little finger. If this movement triggers discomfort on the thumb flank of the wrist, it is a strong indication of de Quervain tenosynovitis.

X-rays and other imaging tests are typically not necessary for diagnosis.

Treatment for De Quervain Tenosynovitis

Treatment aims to reduce inflammation, maintain thumb movement, and prevent recurrence. When addressed early, symptoms normally get better within 4 to 6 weeks. If the condition develops during pregnancy, symptoms often resolve by the end of the prenatal period or breastfeeding.

Treatment options include:

Medications:

Over-the-counter pain relievers like ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) can help lessen pain and swelling.

Corticosteroid injections into the tendon sheath may be recommended to decrease inflammation. When administered within the initial 6 months of symptoms, a single injection is usually effective for full recovery.

Therapies:

Initial therapies may consist of:

  • Immobilisation of the thumb and wrist with a splint or brace to rest and relax the tendons.
  • Avoiding repeated thumb motions whenever possible.
  • Minimising pinching motions during side-to-side movement of the wrist.
  • Applying ice to reduce swelling.

Physical or occupational therapy can include wrist, hand, and arm exercises to strengthen muscles, ease pain and prevent further irritation. Therapists may as well provide strategies to reduce strain on the wrist.

Surgery:

For severe cases, outpatient surgery may be necessary. The surgeon examines and opens the sheath near the affected tendons during the procedure. This helps relieve pressure and allows smoother movement.

After surgery, the GP will guide you on rest, rehabilitation and strengthening exercises to prevent recurrence. A physical or occupational therapist may assist in post-surgery recovery by introducing exercises and modifications to daily activities to minimise future strain.

Conclusion

Don’t ignore the symptoms if you’re experiencing persistent wrist or thumb pain. Early treatment can help prevent further complications and restore full movement. Whether through simple lifestyle adjustments, therapy, or medical intervention, effective treatments are available to relieve pain and improve function.

Schedule an appointment today for a proper diagnosis and to get a personalised treatment plan.