De Quervain’s Tenosynovitis
Irritation and narrowing around two tendons on the thumb side of the wrist, causing pain with gripping, lifting or moving the thumb.
Two tendons that move the thumb travel through a shared tunnel on the thumb side of the wrist. When the tendon lining or the tunnel becomes swollen, the tendons no longer glide comfortably.
Pain is usually felt over the thumb-side wrist and may spread toward the thumb or forearm. Repeated lifting, gripping and wrist motion can make it more noticeable.
Loading anatomy
Common symptoms
- Pain and tenderness on the thumb side of the wrist
- Pain with gripping, lifting, wringing or moving the thumb
- Swelling or a thickened feeling over the tendon tunnel
- Pain that can travel a short distance up the forearm
- A catching or creaking sensation with thumb movement
Causes and contributing factors
- Swelling and irritation in the tendon sheath
- Changes in hand use, including repetitive lifting or gripping
- Pregnancy and caring for a young child can increase load on the thumb and wrist
- Previous wrist injury or inflammatory arthritis may contribute
How it is evaluated
The location of pain and the movements that reproduce it are important. The wrist and thumb are examined directly, and other causes of thumb-side wrist pain are considered.
- Tenderness over the first dorsal wrist compartment
- Pain with resisted thumb movement and specific wrist positions
- Assessment for thumb-base arthritis, tendon instability and nerve symptoms
- Imaging when the examination is atypical or another condition is suspected
Nonsurgical treatment
Initial treatment reduces irritation and limits the movements that repeatedly load the tendon tunnel.
- A thumb-spica splint that supports the thumb and wrist
- Activity modification and changes to lifting or gripping technique
- Anti-inflammatory medication where appropriate and safe
- Hand therapy for movement, load management and gradual strengthening
- A corticosteroid injection into the tendon compartment in selected cases
Surgical treatment
When pain continues despite nonsurgical treatment, release of the tendon compartment may be considered. The goal is to give the tendons enough room to glide without rubbing.
- Release of the first dorsal compartment
- Inspection for separate tendon slips or an additional compartment
- Protection of the small sensory nerve branches during the approach
- Hand therapy when pain or stiffness has changed thumb use
Recovery
Pain from tendon rubbing may improve gradually after the release, while incision tenderness and swelling can take longer to settle.
- Gentle thumb and wrist movement is generally part of recovery
- Heavy gripping and lifting are limited until the wound and soft tissues recover
- Persistent pain can require reassessment for another source of thumb-side wrist pain
When to seek urgent care
Seek immediate medical attention - an emergency department - if you experience:
- Sudden loss of thumb movement after an injury
- A cold, pale or newly numb thumb or hand
- Rapidly increasing redness, swelling, drainage or fever
This list is not exhaustive. If something about your hand worries you, have it looked at.
Frequently asked questions
Is de Quervain’s the same as thumb-base arthritis?
No. De Quervain’s affects tendons on the thumb side of the wrist. Thumb-base arthritis affects the joint where the thumb meets the wrist. The pain can feel close together, so the examination distinguishes them.
Can a splint help?
A splint that supports both the wrist and thumb can reduce tendon motion while the irritation settles. It is usually combined with changes to the activities that aggravate the pain.
Related conditions
Thumb-Base Arthritis
Wear of the joint at the base of the thumb, where the thumb meets the wrist, causing pain with pinching, gripping and twisting.
Tendon Injuries
Cuts, ruptures or damage to the cords that connect muscle to bone and make the fingers and thumb move.
Discuss de quervain’s with Dr. Champagne
A consultation begins with understanding your symptoms, how they affect what you do, and what has already been tried.