De Quervain’s tenosynovitis
De Quervain’s tenosynovitis is inflammation of the sheath. The sheath wraps around two tendons involved in thumb movement. These tendons run from the thumb down the wrist.
Causes of De Quervain’s tenosynovitis
The most common cause of De Quervain’s tenosynovitis is overuse. Overuse can be in the form of repetitive thumb movements at work or during sport. Other causes include injury to the area and pregnancy. A specific cause can not always be identified.
Symptoms of De Quervain’s tenosynovitis
The main symptoms of De Quervain’s tenosynovitis include pain and swelling at the wrist, near the base of the thumb. Movements of the thumb (such as pinching and gripping) can make the pain worse. Occasionally, a crunching noise can occur when the thumb is moved.
Diagnosis of De Quervain’s tenosynovitis
De Quervain’s is commonly diagnosed with a thorough history and examination. Occasionally, if the diagnosis is uncertain, or your pain does not respond to initial treatment, further investigations may be requested (e.g. ultrasound scan) to confirm the diagnosis.
Self management of De Quervain’s tenosynovitis
Rest
Limit hand movements that aggravate your pain. It is important to allow time for your symptoms to settle.
Splinting
Splints can be used to limit thumb movement. Splinting helps with resting the thumb. Splints can be bought off the shelf and are often called a thumb spica splint.
Painkillers
Various over the counter pain killers are available for the management of pain. These can be in the form of tablets or gels. If you have any questions your local pharmacy will be able to advise about what is safe.
Physiotherapy
Stretching and strengthening exercises can be used both to treat the initial flare as well as to reduce the risk of relapse.
Steroid injection
If your symptoms are still present after a referral to physiotherapy and splinting, a steroid injection can be used to help reduce the pain and allow you to continue your physiotherapy.
Exercises for De Quervain’s tenosynovitis
Exercise 1: wrist lateral flexion
- Place your forearm on a surface with your thumb facing upwards.
- Ensure you wrist is not resting on the surface.
- Keeping all your fingers straight, move your hand upwards and downwards in a slow and controlled fashion.
Exercise 2: weighted wrist lateral flexion
- Place your forearm on a surface with your thumb facing upwards.
- Grasp a weighted object (e.g. water bottle).
- Ensure your wrist is not resting on the surface.
- Whilst holding the weighted object, move your hand upwards and downwards in a slow and controlled fashion.
What next?
Exercises, splinting and minimising wrist load will resolve De Quervain’s tenosynovitis in the vast majority of patients.
If you are still suffering despite this, a healthcare professional can arrange a steroid injection. Please book an appointment with your GP to further discuss this option.
Page updated 01/12/2020. Review date 01/01/2024
