De Quervain's tenosynovitis

Key points

1. The condition develops when the tendons around the base of your thumb become irritated or constricted from overuse.
2. The main symptom is pain and swelling at the base of your thumb or at your wrist.
3. 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. 
4. 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. 
5. 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.

What causes de Quervain’s tenosynovitis?

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. 

What are the symptoms of de Quervain’s tenosynovitis?

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.

How is de Quervain’s tenosynovitis diagnosed?

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.

How is de Quervain’s tenosynovitis treated?

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.

How can I care for myself with de Quervain’s tenosynovitis?

• 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 to strengthen the area.
• Apply hot or cold packs to your wrist.
• Take pain relief.

Learn more

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.   

Living with de Quervains tenosynovitis HealthInfo, NZ
Surgery for de Quervain's tenosynovitis HealthInfo, NZ
de Quervains tendinosis OrthoInfo, US

References

1. Goel R, Abzug JM.de Quervain's tenosynovitis – a review of the rehabilitative options Hand. 2015 Mar;10(1):1-5.
2. 10 exercises for de Quervains tenosynovitis Healthline, US
3. Surgery for De Quervain's disease Healthdirect, Australia, 2019
4. Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis – a randomized controlled trial. J Acupunct Meridian Stud. 2014 

Reviewed by

Dr Hemakumar Devan is a postdoctoral fellow conducting health research at the School of Physiotherapy, University of Otago in Wellington. He is interested in developing web-based, culturally-appropriate technologies (eg, online-delivered treatments, apps and websites for supporting self-management and facilitating behaviour change in people with long-term health conditions, particularly those living with persistent pain.

Miranda Bűhler is a physiotherapist and hand therapist with 20 years’ clinical experience. She works at Southern District Health Board. Her clinical and research interests cover a wide range of post-traumatic and long-term conditions involving the hand and upper limb. She is currently completing her PhD at the University of Otago.