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.
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.
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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.
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