De Quervain’s Tenosynovitis
Do you have pain and tenderness on the thumb side of your wrist? This condition causes inflammation of tendons (tendinitis) near the base of your thumb. I specialise in diagnosing and treating this, offering a range of solutions to relieve your pain and restore function. It is a truly debilitating problem…Let me help!
Ali Phillips | Hand & Wrist Specialist
Pain on the thumb-side of your wrist?
I'm Ali Phillips. I understand how frustrating wrist pain can be, and I'm here to help you understand what's happening and how we can work together to fix it.
Book a ConsultationWhat is De Quervain's Tenosynovitis?
Think of two important tendons as special ropes that run from your forearm to your thumb, helping it move. These tendons glide through a small, slippery tunnel at your wrist to keep them in place.
De Quervain's (pronounced "duh-kwer-VAINS") happens when that tunnel becomes too tight, or the tendons themselves get swollen. When that occurs, they can no longer slide easily. This friction causes pain and makes it difficult to use your thumb and wrist.
I often see this in new mothers ("Mummy's Thumb") or people who use their hands repetitively for work or hobbies, like gardening or gaming.
What are the symptoms of De Quervain's?
Pain at Thumb Base
A dull ache or sharp pain on the thumb side of your wrist, often worse with movement.
Swelling or Lump
You might notice swelling or even a small, soft fluid-filled lump (a cyst) in the painful area.
Catching Sensation
A "sticking" or "snapping" feeling when you try to move your thumb.
Ready to Find Relief?
If these symptoms sound familiar, you don't have to just live with them. An accurate diagnosis is the first step towards getting your hand function back. Let's talk about your options.
Find Out Your OptionsDoes this sound like you?
Sarah's Story: The New Mother
Sarah came to see me a few months after her baby was born. She had a sharp pain on the outside of her wrist, right at the base of her thumb. Lifting her baby, twisting open a jar, even holding her phone had become painful. We started with a simple plan: a comfortable splint and new techniques for lifting her baby. When pain persisted, a single cortisone injection gave her significant relief, allowing her to enjoy those precious moments without the constant ache.
Mark's Story: The Gardener
Mark is a keen gardener who loves spending hours outside. He noticed a persistent ache and a "catching" sensation in his thumb, which was affecting his passion. After discussing his options, a cortisone injection gave him significant relief, but the symptoms returned a few months later. We then decided on a minor surgical procedure to release the tight tendon tunnel. Now, he's back to gardening with minimal discomfort.
How will I diagnose your wrist pain?
When you come to see me, I'll start by listening to your story and carefully examining your wrist. One of the tests I use is called the Finkelstein Test. You can try it gently at home, but please stop if it causes significant pain.
1️⃣
Tuck your thumb into your palm.
2️⃣
Gently wrap your fingers over your thumb.
3️⃣
Slowly bend your wrist towards your little finger.
If this causes a sharp pain, it's a strong indicator of De Quervain's. An accurate diagnosis from me is the most important first step to getting you on the road to recovery.
Did the test cause pain?
If you experienced that sharp pain on the side of your wrist, it's a clear sign that you should seek a professional opinion. Don't wait for it to get worse. Let's create a plan together.
Book Your AppointmentHow can I help you get better?
We'll create a treatment plan together, usually starting with the simplest options.
Rest & Activity Modification We'll figure out what movements trigger your pain and find alternative ways to do things.
Splinting I may recommend a special brace to hold your thumb and wrist still, giving the tendons a chance to rest.
Hand Therapy I work with excellent hand therapists who can teach you gentle exercises to help your tendons glide smoothly again.
Anti-inflammatories Over-the-counter medications like ibuprofen can help to manage pain and swelling in the short term.
Corticosteroid Injections For persistent pain, I can administer an injection of strong anti-inflammatory medicine directly into the tendon sheath. This often provides significant relief.
If we've tried the other treatments and your wrist still hurts, we can discuss surgery. My goal with surgery is to solve the problem for good.
What does the surgery involve?
De Quervain's release is a quick, safe, and effective outpatient procedure. I make a small incision at your wrist and carefully open the roof of the tight tunnel. This immediately creates more space for the tendons, allowing them to glide freely without pain.
Benefits
- Lasting pain relief
- Restored thumb movement
- Return to your hobbies and activities
Small Risks
- A small, well-placed scar
- Temporary numbness near the scar
- Infection (very rare)
- Residual pain (about 1 in 20 cases)
The decision to have surgery is one we make together. I will ensure all your questions are answered so you feel confident in our plan.
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always explore other treatment options, or decide on no treatment at this time. The decision is yours.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
I want you to be fully aware that all surgeries carry some risks. For De Quervain's release, the overall complication rate is low. Most complications are minor. Potential issues include:
- Residual Pain: About 1 in 20 patients may not have complete remission of pain. During surgery, I release the "tourniquet" on the tendons, but the underlying inflammation needs time to settle down.
- Injury to the Superficial Radial Nerve (RSN): This nerve runs very close to the surgical area. While direct injury is very rare, the scar can be tender for a time. This can be helped with silicone strips and hand therapy.
- Scar Thickening: It is common for the scar to heal slightly bulky, but this is not usually an issue and settles with time.
- Tendon Shifting (Subluxation): After release, the tendons could shift out of position. This is noted in medical literature but is a very rare occurrence in my practice.
Your Personalised Corner ✨
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Frequently Asked Questions
Sometimes, if it's a very mild case and you can completely stop the activity that's causing it, the symptoms might improve. However, it often requires some form of treatment to fully resolve and prevent it from becoming a chronic issue.
No, they are different conditions. Carpal tunnel syndrome involves a nerve being compressed in your wrist, which typically causes tingling and numbness in your fingers. De Quervain's involves inflammation of tendons on the thumb side of your wrist, causing pain in that specific area.
There can be some discomfort during the injection, but I mix it with a local anaesthetic to numb the area quickly. The site might be a bit sore for a day or two, but this is usually followed by significant pain relief from the condition itself.
Initial recovery involves wound healing for about two weeks, when stitches are typically removed. Most people can return to light activities within a few weeks, but a full return to heavier tasks might take 6-12 weeks. I will refer you to a hand therapist to guide your rehabilitation.
It's a common nickname because hormonal changes and fluid retention during and after pregnancy can contribute to swelling around the tendons. Also, new mothers frequently lift and hold their babies with their thumbs extended in a way that can trigger or worsen the condition.
Test Your Knowledge!
De Quervain’s Tenosynovitis FAQs
De Quervain’s (often pronounced duh-KARE-vains) is a condition involving irritation and swelling of the tendons on the thumb side of your wrist. These tendons travel through a tunnel-like sheath, and when they swell, it causes pain and tenderness.
Most of the time, it’s from repetitive movements involving your thumb and wrist, especially forceful twisting or gripping. New moms are quite susceptible due to how they often lift their babies, but it can stem from work activities, sports, hobbies – anything that repeatedly stresses that area.
It usually starts with pain and tenderness at the base of your thumb, specifically near the wrist. Swelling in that area is common, and you might notice a “catching” or “snapping” sensation when you move your thumb.
Sometimes! For milder cases, resting the affected wrist, avoiding overuse, and simple at-home measures can make a big difference. However, if the pain and swelling are severe, or it fails to improve after a week or so of rest, it’s crucial to seek medical help.
Gentle stretching and range-of-motion exercises can help maintain flexibility in the affected wrist and thumb. It’s best to have a hand therapist or your doctor guide you to avoid exercises that further irritate the tendons.
A lightweight splint that immobilizes your thumb and wrist is frequently recommended. This protects the inflamed tendons and encourages healing. Splints are especially helpful while sleeping when we can sometimes accidentally bend our wrists.
Both can be helpful! Ice in the early stages is better for reducing acute inflammation and swelling. Later on, gentle heat might soothe the tendons and enhance circulation to promote healing. Try alternating sessions.
Over-the-counter pain relievers and anti-inflammatories like ibuprofen or naproxen can offer temporary relief and reduce swelling. In some cases, your doctor might prescribe a stronger pain medication.
Yes, often it’s highly effective. Injecting a steroid and numbing medication directly at the site of inflammation significantly reduces swelling of the tendon sheath. This allows the tendon to glide smoothly again, easing pain and restoring movement.
A hand therapist can design a safe exercise program, teach you ergonomic ways to reduce wrist strain and possibly use techniques like ultrasound to promote healing. Therapy is very helpful alongside other treatments, and also after any injections or surgery. BUT the therapy should NEVER be painful or make you worse!
It’s rarely needed, thankfully! Most cases respond well to rest, splinting, medications, and sometimes targeted injections. However, if it fails to improve, a minor surgical procedure can release the narrowed tunnel for the tendon, easing the pain.
Despite both causing pain around the wrist and thumb, de Quervain’s is specifically about tendon inflammation, while arthritis refers to a disease affecting the joints themselves. Your doctor can determine the right diagnosis with an examination.
Unfortunately, even with successful treatment, some people experience occasional flare-ups. Identifying activities that trigger your symptoms and adjusting your movements can help manage them.
Your primary care doctor can provide an initial diagnosis and guidance. You may be referred to orthopedic or hand surgeons, or to a sports medicine specialist depending on how the condition developed.
Absolutely! Learning how to lift, grip and type in ways that don’t put excessive strain on your thumb and wrist is crucial to both speed up healing and prevent future flare-ups. A Hand Therapist or sports medicine expert can assist with this.
I hope this helps! Always remember, prompt treatment often leads to a faster and more comfortable recovery. ????
