De Quervain’s tenosynovitis is inflammation of the tendon sheath surrounding two thumb tendons on the thumb side of the wrist. It causes pain during gripping, lifting, twisting, or thumb movements and is a common repetitive strain injury (RSI).
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It often occurs in the following sports:
- Tennis and racket sports
- Golf
- Canoeing
- Manual work
- New parents repeatedly lifting babies
Symptoms of De Quervain’s Tenosynovitis
Common symptoms include:
- Pain on the thumb side of the wrist
- Tenderness at the base of the thumb
- Pain when gripping or twisting
- Swelling over the tendons
- Creaking or clicking sensations (crepitus)
- Weak grip strength
Pain is usually worse with repetitive wrist and thumb movements.Symptoms include:
Finkelstein’s test
Finkelstein’s test helps diagnose De Quervain’s tenosynovitis. To perform the test:
- Place your thumb into the palm.
- Wrap your fingers around it.
- Bend the wrist towards the little finger side.
Sharp pain over the thumb side of the wrist suggests a positive test.
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What causes De Quervain’s tenosynovitis
Tenosynovitis is simply the inflammation of the sheath that surrounds the following wrist tendons (connect muscle to bone).
- Abductor pollicis longus
- Extensor pollicis brevis
These tendons pass through a narrow tunnel on the thumb side of the wrist. Repetitive movement causes irritation and thickening of the tendon sheath, making movement painful.
It occurs more frequently in racket sports, such as tennis, squash, or badminton, as well as canoeing and ten-pin bowling. Any sport or work-related activity which involves repetitive wrist flexion and extension or ulna and radial deviation (side-to-side movements) can bring on De Quervain’s tenosynovitis.
It also occurs in golfers (left thumb of a right-handed golfer and vice versa). Tendon injuries such as this are often labelled with the umbrella term RSI (repetitive strain injury).
Treatment for De Quervain’s tenosynovitis
Conservative treatment (without surgery) is usually very successful.
Rest and activity modification
Reduce aggravating activities, especially avoid:
- Repetitive gripping
- Heavy lifting
- Racket sports
- Repeated thumb movements
Ice therapy
Apply cold therapy for 10 minutes at a time to reduce pain and inflammation.
Wrist and thumb supports
A thumb spica splint or wrist support helps rest the tendons.
Ultrasound
Ultrasound therapy applied to the tendons can also help reduce pain and inflammation and encourage the healing process. Ultrasound passes high-frequency sound waves into the tissues vibrating the molecules and resulting in a micro-massage effect.
Anti-inflammatory medication
A doctor may recommend anti-inflammatory medication such as ibuprofen.
Corticosteroid injection
If conservative treatment fails your doctor may try a cortisone injection. This is usually successful in most cases, however in rare cases where both conservative treatment and cortisone injections have failed, then surgery may be indicated.
Exercises
Once the pain has gone, it may be necessary to do wrist and hand exercises to strengthen the whole area. This prepares you for returning to the sport and can help prevent future injury.
When can I return to sport?
Most mild cases improve within 4 to 6 weeks with rest and treatment. More persistent cases may require injections or longer rehabilitation.
You can usually return to sport once wrist and thumb movements are pain-free, grip strength has returned, and you can train without symptoms worsening afterwards. Use our wrist pain return to sport calculator to help assess whether you are ready to return safely.
Surgery
“One steroid injection usually settles the problem. Rarely, surgery is needed to release the tendon sheath and allow the tendons to glide smoothly again.” — Mr Elliot Sorene, Consultant Hand Surgeon
Recommended products
We recommend the following products from our commercial partners (Amazon) for helping with recovery from a Scaphoid fracture:
- Wrist & thumb support: Most important product for this injury. Immobilises the thumb tendons and reduces irritation.
- Therapy putty or hand exerciser: Rebuilds grip strength and targets muscles weakened during immobilisation. One of the most effective rehab tools.
- Hand exerciser/grip strengthener: Allows progressive resistance training and helps with return to sport-specific activity.
- Resistance bands: Used for wrist flexion, extension and radial deviation to restore full strength, not just grip.
- Cold therapy pack & Gel: Useful in the early rehab phase to reduce pain and control inflammation after exercise.
- Heat therapy: Helps reduce stiffness once swelling has settled and is useful before mobility exercises.
References & further reading
- Peters-Veluthamaningal C, van der Windt DA, Winters JC, et al. Corticosteroid injection for de Quervain’s tenosynovitis. Cochrane Database Syst Rev 2009(3): CD005616.
