De Quervain tenosynovitis

De Quervain tenosynovitis is a painful condition of two tendons that run along the thumb side of the wrist on their way to the thumb. The tendons pass together through a narrow tunnel, and when the lining of that tunnel thickens, they no longer glide smoothly. The result is pain near the base of the thumb that worsens with gripping, pinching, or turning the wrist.

• Pain and tenderness on the thumb side of the wrist, near the base of the thumb
• Pain that worsens with gripping, pinching, lifting, wringing, or turning the wrist
• Pain that may spread up the forearm or into the thumb
• Puffiness along the wrist just below the thumb, occasionally with a small fluid-filled lump
• A catching or sticking feeling when moving the thumb
• Difficulty with everyday tasks such as lifting a child or opening a jar

The exact cause is not fully understood. Repeated thumb and wrist motions can aggravate the tendons and their tunnel.

It is more common in:

• Women and middle-aged adults
• Pregnancy and the months after childbirth, often linked to repeatedly lifting and holding a baby
• People with rheumatoid arthritis
• Work, hobbies, or sports that involve repetitive gripping, lifting, or wrist motion

The diagnosis is usually made from your history and an examination. The clinician presses on the thumb side of the wrist and may perform the Finkelstein test: you tuck your thumb into your palm, close your fingers over it, and the wrist is bent toward the little finger. Sharp pain along the thumb side of the wrist suggests de Quervain tenosynovitis. X-rays or ultrasound are sometimes used to rule out other causes, such as arthritis at the base of the thumb.

Non-surgical treatment is tried first:

• A splint that holds the thumb and wrist still, worn during activities that bring on pain and often at night
• Avoiding or changing the motions that trigger symptoms, such as lifting with the thumb spread wide or repeated wrist twisting
• Ice and anti-inflammatory medication when appropriate
• A corticosteroid injection into the tendon sheath, which can reduce pain and swelling

Surgery may be considered when significant pain continues despite non-surgical care. Through a small incision on the thumb side of the wrist, the surgeon opens the tight roof of the tendon tunnel so the tendons can glide freely, taking care to protect the small sensory nerves nearby. It is an outpatient procedure, usually done with local or regional anesthesia.

With splinting or an injection, symptoms may settle over several weeks. After surgery, a dressing or short-term splint is used, gentle thumb motion begins early, and strength returns gradually over several weeks; hand therapy may help. Tenderness at the scar and temporary numbness on the back of the thumb can occur.

Taking breaks from repetitive thumb and wrist motions, keeping the wrist straight while gripping, and lifting with both hands may reduce strain. New parents can try lifting a baby with the palms and forearms rather than with the thumbs spread wide.