Hand and wrist
De Quervain's Tenosynovitis: Thumb-Side Wrist Pain
In short
De Quervain's tenosynovitis is pain on the thumb side of the wrist caused by two thumb tendons being squeezed and irritated in a narrow tunnel; it gets worse with gripping and thumb movement. Treatment usually starts with activity changes, a splint that supports the thumb and wrist, and a steroid injection; combining an injection with a splint has been found to work better than either alone. If these treatments fail, a short operation that opens the roof of the tunnel can be performed.
What is De Quervain's tenosynovitis?
Two tendons that move the thumb upwards and outwards pass through a narrow tunnel on the thumb side of the wrist, close to the bone. When the sheath around these tendons thickens or becomes irritated, the tunnel narrows and the tendons cannot glide freely [1][2].
The result is pain that increases with thumb and wrist movement. This is called De Quervain's tenosynovitis, or De Quervain's disease [1][2].
What are the symptoms?
Symptoms usually come on gradually and increase with use of the hand [1][2]:
- Pain and tenderness on the thumb side of the wrist
- Pain that increases when lifting the thumb, gripping or turning the wrist
- Difficulty with tasks such as using scissors, holding a baby or opening jars
- Mild swelling compared with the other wrist
- Sometimes a catching or clicking feeling when the thumb moves
What causes it, and who is at risk?
In most people no clear cause is found. Frequently repeated thumb and wrist movements, such as long periods of texting, typing or lifting, can make symptoms worse. Work activities rarely cause it on their own, but they may aggravate the pain [1][2].
It is more common in women and in people in their 40s and 50s. Pregnancy, and especially the first weeks after childbirth, is an important risk period; in new mothers it is unclear whether hormonal changes or frequently lifting the baby is responsible. Rheumatoid arthritis may also increase the risk [1][2].
How is it diagnosed?
Diagnosis is usually based on the history and examination. The doctor looks for tenderness and swelling on the thumb side of the wrist [1][2].
The Finkelstein (Eichhoff) test is the most commonly used examination: the thumb is tucked into the palm and held by the other fingers, and the wrist is bent towards the little finger. Pain on the thumb side of the wrist during this movement supports the diagnosis [1].
Non-surgical treatment
The first step is to reduce the movements that increase pain and to use a splint that rests the thumb and wrist. Short periods of ice and painkillers can also ease symptoms [1][2].
A steroid injection into the tendon sheath is an effective treatment that clearly reduces pain in many patients, with a low risk of problems [1][2].
A meta-analysis combining sixteen randomised trials found that steroid injection was more successful than a splint alone, and that using an injection together with a splint gave better results than either on its own [3]. A separate network meta-analysis also supports injection with a short period of immobilisation as the main effective treatment. In the same analysis, shock wave therapy emerged as a possible second-line option, while some alternative injections showed no clear advantage over placebo, so new or costly injection treatments should be approached with caution [4].
When is surgery needed?
Surgery may be considered if symptoms continue despite splinting, activity changes and injection [1][2].
Through a small cut at the wrist, the roof of the tunnel is opened to give the tendons more room. Pain often settles quickly after the operation [1][2].
Possible problems include a scar that stays tender for a few weeks, temporary numbness from irritation of a small sensory nerve in the area, stiffness and, rarely, infection [2].
Recovery
With appropriate treatment, most patients' symptoms improve [1]. After an injection it helps to avoid straining movements and to wear the recommended splint; an injection combined with a splint gives better results than an injection alone [1][3].
After surgery, the hand can soon be used for light tasks. The scar may look red and feel tender for a few weeks before it softens [2].
When should you see a doctor promptly?
Do not delay an assessment in the following situations [1][2]:
- Pain that interferes with daily tasks, caring for a baby or sleep
- Symptoms that have not settled after a few weeks of rest and splinting
- Marked swelling, redness or warmth at the wrist
- Numbness of the thumb or back of the hand that does not settle after surgery
Frequently asked questions
+What causes wrist pain on the thumb side?
A common cause of pain on the thumb side of the wrist that worsens with thumb movement and gripping is De Quervain's tenosynovitis. Pain reproduced by the Finkelstein test during examination supports the diagnosis [1][2].
+Why do new mothers get wrist pain after childbirth?
Pregnancy and the period after childbirth are a known risk time for De Quervain's tenosynovitis. It is not clear whether hormonal changes or frequently lifting the baby plays the main role [1][2].
+Does De Quervain's tenosynovitis go away on its own?
Symptoms may ease with fewer straining movements and a splint. If they do not, a steroid injection is an effective option, and results are better when it is combined with a splint [1][3].
+Does a steroid injection work for De Quervain's?
Yes. Research shows that a steroid injection is more effective than a splint alone, and that combining an injection with a splint gives the best results [2][3][4].
+How long is recovery after De Quervain's surgery?
Pain often settles quickly and the hand can soon be used for light tasks. The scar may be tender for a few weeks, and temporary numbness can occur [2].
Sources
- [1]De Quervain's Tenosynovitis — American Academy of Orthopaedic Surgeons (OrthoInfo).
- [2]De Quervain's Syndrome — British Society for Surgery of the Hand (BSSH).
- [3]Corticosteroid injection versus immobilisation for the treatment of De Quervain's tenosynovitis: A systematic review and meta-analysis — Hand Surgery and Rehabilitation (Cevik J, et al.), 2024.
- [4]Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis — The Journal of Hand Surgery (Chong HH, et al.), 2024.
This article is general information and does not replace an examination or personal medical advice. In an emergency, go to the nearest emergency department.