De Quervain's tenosynovitis is an inflammation of the tendons on the thumb side of the wrist, causing pain and swelling.
Two tendons run along the thumb side of the wrist, on their way from the forearm to the thumb, through a narrow tunnel formed by a fibrous sheath. De Quervain's tenosynovitis is inflammation and thickening of this sheath, which narrows the tunnel and causes pain and sometimes a catching sensation as the tendons try to glide through it.
It is one of the most common causes of pain at the base of the thumb and is a specific, well-recognised form of wrist tendinitis. It is frequently seen in new parents, from the repetitive lifting and thumb positions involved in caring for a baby, though it affects a much wider range of people.
De Quervain's tenosynovitis is typically triggered by repetitive thumb and wrist movements, particularly a combination of gripping with the thumb extended and moving the wrist side to side. Common triggers include lifting and carrying a baby, particularly with the thumbs under the arms, frequent texting or scrolling, repetitive gripping tasks at work, and gardening or racquet sports.
It is notably more common during pregnancy and in the months after childbirth, likely related to a combination of hormonal changes and the repetitive lifting involved in caring for an infant. It can also occur without any clear repetitive trigger.
The main symptoms of De Quervain's tenosynovitis are:
Pain is often reproduced by making a fist over the thumb and bending the wrist toward the little finger, a simple test commonly used during assessment.
Diagnosis is usually made through history and examination, reproducing pain with specific thumb and wrist movements. Imaging is not always required but can be used if the diagnosis is uncertain.
Initial treatment focuses on settling the inflamed tendon sheath: a thumb splint to rest the affected tendons, activity modification to reduce the aggravating movement, ice, and simple anti-inflammatory medication. Physiotherapy can help with technique adjustment for the underlying cause, particularly where a specific repetitive task, such as lifting a child, is involved.
A corticosteroid injection into the tendon sheath is often very effective and is a common next step if splinting alone does not fully settle symptoms.
Surgery, known as De Quervain's release, is considered for the minority of cases that remain symptomatic despite splinting and injection. It involves releasing the tight tendon sheath to allow the tendons to glide freely.
The outlook for De Quervain's tenosynovitis is good. Many cases, particularly when caught early, settle with splinting and activity modification alone. A corticosteroid injection is often effective when symptoms are more established, and this frequently avoids the need for surgery altogether.
For the smaller number of cases that need surgery, results are generally good, with most patients experiencing substantial relief of pain and a return to normal thumb and wrist function.
De Quervain's tenosynovitis is a common and generally very treatable cause of thumb-side wrist pain, often related to repetitive gripping or lifting tasks. Most cases settle with splinting, activity modification and, where needed, an injection, with surgery reserved for those that do not respond. Persistent pain at the base of the thumb, particularly with gripping or lifting, is worth having assessed.
