Hand Therapy – De Quervain’s Tenosynovitis: Inflammation of the Tendons of the Thumb

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is caused by rubbing of the two tendons that sit at the base of your thumb and wrist. The tendons sit in a tendon sheath. This rubbing causes a thickening and narrowing of the tendon sheath which leads to pain and inflammation.

What is the cause of De Quervain’s Tenosynovitis?

Although the exact cause of De Quervain’s is unknown, there may be some risk factors such as:

• Overuse of the wrist and hand, such as an increase or change in your activity, for instance DIY, gardening, new sport or job.

• Thumb injuries or strain.

• Inflammatory conditions.

• Hormonal changes associated with pregnancy.

What are the symptoms?

The symptoms include:

• Pain on the thumb side of the wrist.

• Pain that worsens with gripping, pinching or twisting movements.

• Tenderness if you press on the site of pain.

• Swelling may occur on this area.

• Clicking or snapping sensation of the tendons.

What is the treatment?

The majority of symptoms associated with De Quervain’s Tenosynovitis will settle with rest and activity modification.

Things that you can do to help:

• Rest: Avoid aggravating movements or activities that increases pain.

• Ice: apply ice pack or a bag of frozen peas wrapped in a towel over painful area and leave on for 20 minutes every 4 hours. Check the skin and do not use if you have circulatory or peripheral nerve problems.

• Splint: wear a thumb/wrist splint which you can buy online or at a pharmacy, to allow symptoms to settle. The splint will need to be worn at all times for a minimum of 6 weeks.

• Pain relief: speak with a pharmacist if you are unsure which medication may help.

What if my symptoms do not improve with self-management?

If symptoms fail to respond following self-management, you may be offered:

Steroid injection: to reduce pain and swelling.

A steroid is a strong anti-inflammatory that will help to reduce any swelling in the area. It relieves the pain in about 70% of cases. It may take up to 6 weeks for the injection to be effective. Following injection, you will be given a wrist/thumb splint to wear for 2 weeks to rest the thumb. If the first injection only gives temporary relief, then you may be offered a repeat injection.

What if my symptoms do not improve following steroid injection?

If steroid injection fails to relieve your symptoms, then you may be offered surgery.

Surgery: surgical decompression of the tendon sheath.

This is done under local anaesthetic. Local anaesthetic numbs this part of the body. It does not lead to loss of consciousness (will not make you go to sleep); it will just stop you from feeling pain.

The surgery lasts approximately 30 mins. You will not need to stay in hospital overnight.

The Surgeon will make as small cut along the thumb side of your wrist, about 2 cm in length. The aim of the surgery is to open-up the tendon sheath and allow the tendons to move freely and comfortably. The wound will be closed with dissolvable stitches.

Following surgery, the hand will be bandaged for 48 hours. After this you can move your wrist and fingers freely to regain movement. You will have your wound checked at 14 days. This appointment will be arranged for you. Returning to work will depend on your type of job. Your surgeon will advise you on this. You will not be able to drive for 2 weeks.

If steroid injection or surgery are not an option; e.g., patients who are pregnant or breastfeeding, and those patients with unstable diabetes, then you will be referred to hand therapy.

What if I have been referred to hand therapy?

Your hand therapist will provide you with a customised plastic splint.

This will support your thumb and wrist and will allow the pain to settle.

Your hand therapist will advise you how to care for your splint.

Following the splinting period, if your symptoms have significantly improved, your hand therapist will instruct you on an exercise programme.

Contact Details

North Tees and Hartlepool NHS Foundation Trust

iMSK Advanced Assessment
Telephone: 01429 522471
Email: n[email protected]
Monday to Friday, 8:30 am to 4:30 pm

References

• Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain’s disease: A systematic review and meta-analysis. J Hand Ther. 2016 Jan-Mar;29(1):3-11. doi: 10.1016/j.jht.2015.10.004. Epub 2015 Nov 6. PMID: 26705671.

• Goel R, Abzug JM. de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015 Mar;10(1):1-5. doi: 10.1007/s11552-014-9649-3. PMID: 25762881; PMCID: PMC4349843.

• Allbrook V. ‘The side of my wrist hurts’: De Quervain’s tenosynovitis. Aust J Gen Pract. 2019 Nov;48(11):753-756. doi: 10.31128/AJGP-07-19-5018. PMID: 31722458

• The British Society for surgery of the hand: De Quervains Syndrome

• Cevik, J., Keating, N., Hornby, A., Salehi, O., Seth, I. and Rozen, W.M., 2024. Corticosteroid injection versus immobilisation for the treatment of De Quervain’s tenosynovitis: A systematic review and meta-analysis. Hand Surgery and Rehabilitation, 43(3), p.101694.

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).