De Quervain's tenosynovitis

Also known as de Quervain's tendonosis

De Quervain’s tenosynovitis is a painful condition affecting the tendons (part of your muscles) you use to straighten your thumb. It happens when the tendons around the base of your thumb become irritated or constricted from overuse. This causes pain along the thumb side of your wrist with some actions such as grasping, gripping or when turning your wrist.

Key points

  1. De Quervain’s tenosynovitis is a common inflammatory condition that causes pain and tenderness along the thumb side of your wrist. 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. 
  2. Specific activities that may be painful include wringing a washcloth, gripping a golf club, lifting a child, or hammering a nail. The inflammation gets worse if you keep doing these or similar functional activities.
  3. 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. 
  4. 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.
  5. There is a range of treatments depending on the severity of your symptoms as well as steps you can take yourself to relieve the pain and inflammation.

What are the causes of 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.  

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, 2017
Surgery for de Quervain's tenosynovitis HealthInfo, NZ, 2017
de Quervain's Tenosynovitis Merivale Hand Clinic, NZ
Tendinopathy and tenosynovitis Patient Info, UK, 2016
Surgery for De Quervain's disease Better Health Australia, 2017
de Quervains syndrome The British Society for Surgery of the hand, UK, 2016
de Quervains tendinosis OrthoInfo, US, 2013

References

  1. de Quervain's tenosynovitis – a review of the rehabilitative options Hand. 2015
  2. 10 exercises for de Quervains tenosynovitis
  3. Surgery for De Quervain's disease Better Health Australia, 2017
  4. Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis – a randomized controlled trialJ 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.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Hemakumar Devan Last reviewed: 26 Feb 2018