De Quervain's tenosynovitis is irritation and thickening of the sheath that surrounds two thumb tendons at the wrist. The tendons run through a narrow tunnel along the thumb side of the wrist, just above the base of the thumb. When the lining of that tunnel thickens, the tendons rub as the thumb and wrist move, and the area becomes painful and sometimes swollen.
Symptoms
- Pain on the thumb side of the wrist, which can spread towards the thumb or up the forearm.
- Tenderness, and sometimes a firm swelling, over the bony point on the thumb side of the wrist.
- Pain when gripping, pinching, lifting a baby, turning a key or wringing clothes.
- A catching or creaking feeling when the thumb moves, in some people.
- Tingling over the back of the thumb in some cases, from irritation of a small nearby nerve.
What causes it
Most often it follows repeated or sustained thumb and wrist loading: lifting a young child with the thumb hooked out, long hours on a phone, tool or machine work, racket sports, and carrying loads. It is seen more often in women, and it is common in the months after childbirth. A direct knock to the wrist, or an inflammatory arthritis, can also bring it on. In many people no single cause is found.
New mothers and daily phone use
Lifting and feeding an infant keeps the thumb and wrist under load many times a day, which is why the problem is so often seen in the first months after delivery. Splinting, a change in how the baby is held, and time are the usual approach, and any medicine is chosen with breastfeeding in mind and discussed with the treating doctors. For heavy phone users, using both hands and voice typing reduces the load on the thumb.
How it is assessed
The diagnosis is mostly made in the clinic. The doctor looks for tenderness over the tendon tunnel and uses Finkelstein's test: the thumb is tucked into the palm, the fingers close over it, and the wrist is tilted towards the little finger side. Sharp pain over the thumb side of the wrist supports the diagnosis.
Other problems can feel similar, and they are worth ruling out: arthritis at the base of the thumb, a scaphoid or other wrist fracture after a fall, irritation of a nerve branch, and tendon irritation higher on the forearm. An X-ray is used when a bone or joint cause is suspected. An ultrasound is sometimes added.
Treatment without surgery
Most people are treated without an operation. After assessment, the plan usually includes:
- Changing the tasks that provoke the pain, for example lifting a child with the whole palm and forearm taking the weight rather than the thumb alone.
- A thumb spica splint, which rests the thumb and wrist for a few weeks as advised. It is often worn for part of the day and at night.
- Pain-relieving medicines or gels, as advised by the doctor.
- Hand therapy: gentle stretching, then strengthening once the pain has settled.
- Where indicated, a steroid injection into the tendon sheath may be considered for short-term relief; possible effects include soreness, a change in skin colour and thinning of fat at the site, and in people with diabetes it can raise blood sugar for a few days.
Improvement is commonly seen over several weeks, and some people take longer. The condition can return if the same movements continue unchanged.
When surgery is considered
Surgery is considered when pain continues despite a proper trial of splinting, activity change and other treatment, or when the problem is stopping work or daily tasks. It is not a first step.
The release is done as a day-care procedure under local anaesthesia. A small cut is made over the thumb side of the wrist. The roof of the tendon tunnel is opened so that the two tendons have room to glide, and the small sensory nerve branches in the area are identified and protected. The thumb and fingers are kept moving soon after, with a dressing or splint for comfort. The stitches come out at about two weeks.
Light use of the hand usually returns at about two weeks, and heavy gripping usually waits until about six weeks. General risks include scar tenderness, numbness or tingling over the back of the thumb from the small nerve branches, stiffness, a tendon slipping out of its groove, infection, and pain that is only partly relieved.
When to see a doctor
- Thumb-side wrist pain that has lasted more than two to three weeks, or is getting worse.
- Pain that wakes you at night, or a grip that has become weak.
- Wrist pain after a fall or a direct blow, which may be a fracture.
- Numbness or tingling that is spreading in the hand.
A hot, red, swollen wrist, especially with fever, needs urgent medical care.
How to book
To book an OPD visit, use WhatsApp or the clinic and hours page, and bring any earlier wrist X-ray.