De Quervain's Wrist Pain

De Quervain’s tenosynovitis, sometimes called De Quervain’s tendinopathy, is a painful irritation of the tendons on the thumb side of the wrist. It’s easy to recognise: pain that makes lifting a kettle, wringing a cloth, picking up a baby or opening a jar feel sharp and weak. It’s very common in new parents, people who grip a lot at work, and heavy phone users, and it generally responds to a combination of load management, support and strengthening.

Understanding De Quervain’s tenosynovitis

Two tendons, the abductor pollicis longus and extensor pollicis brevis, run together through a narrow tunnel on the thumb side of the wrist, where they pull the thumb away from the hand. Repeated or forceful thumb and wrist movements, especially bending the wrist toward the little finger while the thumb is gripping, can irritate the tendons and thicken the tunnel’s lining, so the tendons no longer glide freely.

Symptoms we commonly see

• Pain and tenderness on the thumb side of the wrist, sometimes spreading into the thumb or forearm
• Pain with gripping, pinching, lifting, twisting or wringing
• Swelling or a thickened feel over the thumb side of the wrist
• Pain when moving the thumb or bending the wrist toward the little finger
• Sometimes a catching or creaking sensation when the thumb moves
• Difficulty with everyday tasks, like opening jars or holding a phone

Our evidence-based approach

Non-surgical management relies mainly on splinting, corticosteroid injection and activity modification, and a multimodal approach seems to work better than any single treatment. The evidence for different physiotherapy approaches is limited, so we focus on what’s well supported and tailor it to you. Our approach includes:

1. Assessment of the wrist, thumb, forearm and neck, to confirm De Quervain’s and rule out other causes of wrist and thumb pain, such as arthritis at the base of the thumb or a nerve problem
2. Activity and ergonomic advice, including how you lift, grip and hold your phone, and for new parents, how to carry and lift a baby in a way that spares the thumb
3. Splint advice, using a thumb support during aggravating tasks and as needed, rather than all the time
4. Taping where it helps unload the tendons
5. Hands-on treatment or dry needling where it eases symptoms alongside the rest of your plan
6. Progressive strengthening of the thumb, wrist and forearm, once pain allows, to restore grip and capacity
7. Coordination with your GP on a corticosteroid injection when it’s likely to help, and referral if symptoms persist

See our carpal tunnel and tennis elbow pages for other common hand, wrist and forearm problems.

What to expect: recovery timeline

• Early or mild cases: often improve over several weeks once the aggravating loads are reduced and a splint is used as needed
• Established cases: can take a few months, and an injection may speed up pain relief
• Persistent cases: are reviewed with your GP or a specialist, with surgery considered if conservative care hasn’t worked

When to seek help urgently

Get assessed promptly if your wrist pain follows a fall or injury, your wrist or thumb is hot, red and swollen, or you have constant numbness, weakness or loss of movement in the thumb or fingers. Wrist pain with fever or feeling unwell also needs prompt review.

References

• Huisstede BM, Gladdines S, Randsdorp MS, Koes BW. Effectiveness of conservative, surgical, and postsurgical interventions for trigger finger, Dupuytren disease, and De Quervain disease: a systematic review. Arch Phys Med Rehabil. 2018;99(8):1635-1649.e21.
• Abi-Rafeh J, Kazan R, Safran T, Thibaudeau S. Conservative management of de Quervain stenosing tenosynovitis: review and presentation of treatment algorithm. Plast Reconstr Surg. 2020;146(1):105-126.
• Menendez ME, Thornton E, Kent S, Kalajian T, Ring D. A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. Int Orthop. 2015;39(8):1563-1569.