Overview 

Have you ever experienced a sharp pain at the base of your thumb, particularly when moving or gripping objects? If so, you might be dealing with De Quervain’s tenosynovitis (pronounced dih-kwer-VAIN ten-oh-sine-oh-VIE-tis), a condition which affects the tendons controlling thumb movement. This condition is relatively common and, with proper treatment, entirely manageable. Understanding its causes, symptoms, and treatment options can help those affected find relief and prevent further complications.

What is de quervain’s tenosynovitis?

De Quervain’s tenosynovitis is also known as:

• De Quervain’s syndrome
• De Quervain’s disease
• De Quervain's tendinosis
• De Quervain's tendinitis
• Gamer's thumb
• Texter's thumb
• Mother’s thumb
• Mommy thumb 

Named after the Swiss physician, Fritz De Quervain, who first described it, De Quervain’s tenosynovitis (DQT) is a degenerative condition affecting the tendons on the thumb side of the wrist.¹ Specifically, it involves the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons, which pass through a fibrous sheath called the extensor retinaculum, which covers the first dorsal compartment.² Thickening of the extensor retinaculum is caused by overuse and repetitive movements of the wrist and thumb, such as excessive mobile phone use, lifting children, gardening, exercise or work involving repetitive gripping. This overuse can potentially cause inflammation and thickening or swelling of the tendons and stenosis (narrowing) of the surrounding sheath. This leads to progressively worsening pain along the thumb-side of the hand, wrist and forearm due to restriction of movement of the tendons housed within the extensor retinaculum.³ 

Causes and risk factors

The exact cause of DQT is unclear, but several risk factors appear to contribute to its development:⁴

Repetitive hand and wrist movements

Activities which increase strain on tendons involved in a movement of the thumb called radial abduction, where the thumb is moved away from the palm:

• Lifting a child
• Gardening
• Sports such as golf, lacrosse, hockey or racket sports
• Knitting
• Playing musical instruments
• Prolonged mobile phone use
• Computer or laptop use
• Regular video gameplay
• Weightlifting
• Professions which require repetitive hand or wrist movements
  • E.g., military personnel, nurses and construction workers
  • Although the British Health and Safety Executive (HSE) states that physically demanding and repetitive work puts workers at increased risk of developing DQT, the opinion of the British Orthopaedic Association (BOA) is that DQT is “rarely caused by occupation”⁵ 

Pregnancy and postpartum changes

In addition to the repetitive hand movements associated with caring for an infant (such as lifting and breastfeeding or bottle-feeding), hormonal fluctuations are also thought to be a DQT risk factor.⁶ One study found that heavy infants or twins do not increase the chances of developing DQT.⁶ However, being overweight, first-time pregnancy and long pregnancies are thought to increase the risk of oedema (swelling) in the first dorsal compartment, resulting in DQT.⁶ 

Chronic conditions

Diseases such as rheumatoid arthritis, diabetes, lupus, and hypothyroidism can increase inflammation and, thus, the risk of developing DQT.⁷

Sex, age and ethnicity

Age, ethnicity and sex are associated with DQT diagnosis, potentially due to differences in tendon structure and hormone-related changes:

• Those assigned female at birth (AFAB) are 2.6 times more likely to be diagnosed with DQT than those assigned male at birth (AMAB)⁷
• Individuals aged 40-59 years have an increased risk of diagnosis⁷
• Black people are more likely to be diagnosed than white people⁷

Symptoms of de quervain’s tenosynovitis

The hallmark symptom of De Quervain’s tenosynovitis is swelling, tenderness and pain along the radial (thumb) side of the wrist, often radiating towards the forearm. Other key symptoms include:

• Difficulty with thumb and wrist movements:
  • Activities such as pinching, gripping, and twisting the wrist become painful and challenging
• A clicking, snapping or sticking sensation when moving the thumb⁸

Diagnosis

In addition to symptom presentation, DQT can be diagnosed through a combination of clinical evaluation and physical examination.

Finkelstein test is considered the gold standard for diagnosing DQT, however, Wu et al. contend that many researchers, clinicians and research manuals describe what is, in fact, Eichhoff’s test.⁹ 

• Finkelstein test: This simple diagnostic test can be divided into 3 stages.¹⁰ It involves placing the arm on the examination table with the wrist over the edge:
  • With the hand and thumb relaxed, bend the wrist toward the little finger with the help of gravity
  • With the hand relaxed, the examiner applies light pressure to cause the wrist to bend toward the little finger
  • With the hand relaxed, the examiner pulls the thumb across the palm

• If any of these manoeuvres cause pain over the base of the thumb, the test is considered positive⁹
• Eichhoff’s test: This test is controversial due to the number of false positives and lack of research on its accuracy.⁹ It requires the patient to make a clenched fist. The examiner applies light pressure to cause the wrist to bend towards the little finger
  • The test is positive if pain is felt at the base of the thumb

• Ultrasound imaging: Ultrasonography can confirm tendon thickening and inflammation¹¹ 
• X-ray imaging: While not typically required, X-rays may be used to rule out other conditions or injury¹²

Treatment of de quervain’s tenosynovitis 

Treatments for DQT are chosen based on severity, duration of DQT and previous treatments, starting with non-steroidal anti-inflammatory drugs (NSAIDS) and surgery being a last resort.¹³ 

Non-surgical treatment options

Most cases of DQT respond well to conservative (non-surgical) treatments. The primary goal is to reduce inflammation, relieve pain and restore function.

Activity modification

Avoiding repetitive movements and heavy lifting can prevent the progression of DQT. Ergonomic adjustments to workplace setups, lifestyle, sporting and limiting the amount of time spent participating in triggering activities may help.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Usually, the first step in treatment options for DQT, the use of oral and topical medications such as ibuprofen and naproxen, help reduce pain and swelling, though scientific literature does not support their effectiveness.¹³ 

Splinting

A splint or cast (particularly thumb spica immobilisation, ideally for 3-4 weeks) immobilises the thumb and wrist, allowing the tendons to rest and heal. Immobilisation is particularly effective when worn at night or during activities which trigger pain. Though effective, complaints surrounding heat and discomfort due to poor fit often arise.^13,14 

Corticosteroid injections

A corticosteroid injection directly into the inflamed tendon sheath provides significant relief by reducing inflammation. Corticosteroid injections, which are safe, effective, affordable and have a low risk of adverse effects, are widely used and can be either ultrasound-guided or blind.¹³ 

• Up to 83% experience pain relief following corticosteroid treatment¹⁵
  • 62% to 100% see improvement after the first injection¹¹
  • A second injection is administered 2 weeks after the first if there is no sign of improvement¹¹
  • If there is no improvement 2 weeks after the second injection, then surgery is recommended¹¹
• Significant improvement has been noted with the combination of corticosteroid injections and splinting¹³

Physiotherapy and stretching exercises

A physiotherapist can provide gentle stretching and strengthening exercises to improve tendon mobility and prevent stiffness once swelling and pain have been treated.¹¹ Soft tissue massage, mobilisation, therapeutic Kinesio taping, manipulation, range of motion exercises and ultrasound therapy may also enhance recovery.¹¹

Novel non-surgical treatments 

• Hyaluronic acid injections, extracorporeal shockwave therapy, acupuncture, ultrasonographic therapy and laser therapy all encourage healing^3,13
• Platelet-rich plasma injection can also stimulate tendon healing¹⁶ 

Surgical treatment

Surgery is considered when conservative treatments for DQT fail or symptoms persist for more than 6 months.¹¹ The surgical procedure, known as first dorsal compartment release, involves making a small incision over the wrist and carefully opening the tendon sheath to relieve pressure. This surgery can be either open or tendoscopic. This allows the tendons to move freely without restriction.¹⁷ 40% of the population have a subcompartment, which separates the EPB from the AP, that should also be identified and released for a positive outcome.¹⁷  

Success rate, complications and recovery

• Surgical treatment has a high success rate (95%), with most patients experiencing complete symptom relief 6-12 weeks post-surgery¹⁷  
• About 11% experience complications post-surgery¹⁷
  • Complications include infection, injury to the superficial radial nerve (RSN), scar hypertrophy, and volar subluxation¹⁷
• Post-surgery rehabilitation includes physiotherapy, scar management and gradual return to activity over 6 to 8 weeks

Long-term rehabilitation 

Regardless of treatment choice, proper rehabilitation is crucial for full recovery and preventing recurrence. Key strategies include:

• Gradual strengthening: Once pain subsides, gentle strengthening exercises help restore grip strength
• Ergonomic adjustments: Using ergonomic keyboards, cushioned mouse pads, wrist-guards and prioritising proper wrist positioning reduces strain
• Avoiding repetitive strain: Modifying repetitive movements and tasks can prevent re-injury

Summary

• De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, often caused by repetitive movements, pregnancy or inflammatory conditions
• Early diagnosis is key to preventing worsening symptoms and long-term complications
• Non-surgical treatments such as rest, splinting, NSAIDs, corticosteroid injections and physiotherapy are effective for most individuals
• Surgical intervention may be necessary in severe or persistent cases, with high success rates and minimal complications
• Rehabilitation and prevention focus on strengthening exercises, ergonomic adjustments and activity modification to reduce recurrence
• Seeking medical advice at the first sign of persistent wrist pain can lead to faster recovery and prevent chronic issues
• With adequate treatment and care, most people can regain full hand function and return to their daily activities pain-free