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

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is the term used to describe inflammation of two tendons that sit at the base of your thumb and wrist.

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 as:

• Overuse of wrist and hand, such as 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 off the shelf or custom made to allow symptoms to settle. The splint will need to be worn 24/7 for a minimum of 6 weeks

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

• Hand therapy/physiotherapy: when symptoms are settling, you can start some exercises to regain range of motion, strength and function.

If symptoms fail to respond following six weeks of splinting, you may be offered:

• Steroid injection: to reduce pain and swelling.

• Surgery: surgical decompression of tendon sheath. 

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 splint must be worn full time for 6 weeks.

How do I care for my splint?

• Wear your splint as advised by your therapist. 

• Keep the splint clean and dry.

• DO NOT try to alter your splint.

• Keep away from sources of heat.

• You may clean the splint with baby wipes/a damp cloth.

Please be aware that wearing a splint continuously can cause irritation to the skin on your hand. If your skin becomes red, dry or blistered, or if you notice the splint rubbing or digging into your skin, please contact your Hand Therapist immediately.

What exercises can I do?

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

Stage One

Complete the exercises 3 to 4 times a day.

Exercise 1:  Assisted Thumb Extension

Sit up straight with arm resting on a table, palm down. Lift your thumb up towards the ceiling. Use the opposite hand to assist the thumb movement. Slowly and smoothly, allow your thumb to return to the starting position, unaided.

Repetition: x10 Hold: 5 to 10 seconds.

Exercise 2:  Assisted Thumb Abduction

Sit up straight with you little finger resting on the table.  Use your opposite hand to lift your thumb up and away from your index finger.

Slowly and smoothly, allow your thumb to return to the starting position, unaided.

Repetition: x10 Hold: 5 to 10 seconds.

Exercise 3:  Assisted Wrist Deviation

Support your forearm on a table with your wrist on the edge and thumb pointing upwards. Slowly lower your wrist towards the floor until you start to feel a stretch felling or discomfort. Then use the other hand to bring the wrist to the start position.

Repetition: x10 Hold: 5 to 10 seconds.

Stage Two

Complete the exercises 3 to 4 times a day. Only progress to these exercises when Stage One exercises can be performed easily and without discomfort.

Exercise 4: Active Thumb Extension

Sit up straight with arm resting on a table, palm down.

Lift your thumb up towards the ceiling.

Hold: 5 to 10 seconds and then return to the starting position.

Exercise 5: Active Thumb Abduction

Sit up straight with you little finger resting on the table. Lift your thumb up and away from your index finger.

Hold: 5 to 10 seconds and then return to the starting position.

Stage Three

Your physiotherapist will advise you when you can progress to Stage Three. Complete the exercises 2 times a day.

Exercise 6: Isometric Wrist Hold

With your forearm and elbow supported on a table, wrist free (as picture). Hold a small weight/water bottle in this position, without any movement, for 20 to 40 seconds.

Repetition: x10 Hold: 20 to 40 seconds.                   

Exercise 7: Thumb Strengthening

Place a small elastic band around the outside of your thumb and index finger and pull these two fingers away from each other. Repeat with your thumb and the other fingers. To progress, repeat with a thicker elastic band.

Repetition: x10 Hold: 5 to 10 seconds.        

Exercise 8: Resisted Wrist Deviation

With your forearm and elbow supported on a table, wrist free (as picture). Hold a small weight/water bottle and allow your wrist to drop downwards. Hold: 5 to10 seconds and then use your other hand to lift your hand back to the starting position

Repetition: x10 Hold: 5 to 10 seconds.            

Contact Details

Please contact Hand Therapy if you have any concerns or questions, or if your splint is rubbing or is uncomfortable.

Contact details are:

North Tees and Hartlepool NHS Foundation Trust

Hand Therapy Team

Telephone: 01429 522471

Monday to Friday, 08:30 a.m. to 04:30 p.m.

You will be asked to attend either:

University Hospital of North Tees

Hand Therapy

1st Floor, North Wing

Hardwick Road

Stockton-On-Tees

TS19 8PE

University Hospital of Hartlepool

Physiotherapy Outpatients Department

Ground Floor

Holdforth Road

Hartlepool

TS24 9AH

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

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