De Quervain’s Tenosynovitis: Relief for Thumb and Wrist Pain

De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist. If you have this condition, it will likely hurt when you turn your wrist, grasp anything, or make a fist. While the exact cause is often unknown, it is generally attributed to thickening and swelling of the sheath that surrounds the two tendons that control thumb movement.

In the UK, this is a common form of repetitive strain injury (RSI). It often affects individuals aged between 30 and 50. According to NICE (National Institute for Health and Care Excellence) guidelines, management focuses on reducing inflammation and preventing recurrence by modifying the activities that triggered the symptoms.

Recognising the signs

The primary symptom of De Quervain’s is pain or tenderness at the base of the thumb. This pain may travel up the forearm. Other symptoms include:

• Swelling near the base of the thumb.
• A 'snapping' or 'sticking' sensation when moving the thumb.
• Difficulty moving the thumb and wrist when doing activities that involve grasping or pinching.

The Finkelstein Test

Doctors often use the Finkelstein test to diagnose the condition. To perform this, you bend your thumb across the palm of your hand and cover it with your fingers to make a fist. You then bend your wrist toward your little finger. If this causes sharp pain on the thumb side of your wrist, it is a strong indicator of De Quervain’s tenosynovitis.

Chronic overuse of the wrist is the most common culprit. Everyday movements like lifting a child, gardening, or repetitive typing can lead to irritation. In the UK, it is sometimes referred to as 'mother's thumb' or 'gamer's thumb' due to the specific repetitive motions involved in these roles.

Other risk factors identified by the NHS include:

• Pregnancy: Hormonal changes and fluid retention can increase the risk of tendon swelling.
• Inflammatory conditions: People with rheumatoid arthritis are more likely to develop tenosynovitis.
• Age and Gender: It is significantly more common in women than men and typically occurs in middle age.

Treatment for De Quervain’s tenosynovitis aims to reduce inflammation, preserve movement in the thumb, and prevent recurrence. Most patients respond well to non-surgical interventions over a period of 4 to 6 weeks.

• Rest and Activity Modification: Avoiding the repetitive motions that caused the pain is the first step.
• Splinting: A thumb-spica splint helps to immobilise the thumb and wrist, allowing the tendons to rest.
• Pain Relief: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce swelling and pain. Always consult a healthcare professional before starting new medication.
• Physiotherapy: A therapist can suggest exercises to strengthen muscles and reduce the load on the tendons.
• Steroid Injections: If symptoms are severe, a GP or specialist may recommend a corticosteroid injection into the tendon sheath.

If you are experiencing persistent wrist pain that interferes with your daily life, it is important to seek medical advice. You can speak to a GP online to discuss your symptoms and receive a preliminary assessment. An online consultation is a convenient way to determine if your pain is likely De Quervain’s or another condition like osteoarthritis or a scaphoid fracture.

An online doctor can provide:

• Advice on the best type of thumb support or splint to purchase.
• Prescriptions for stronger anti-inflammatory medication if appropriate.
• Guidance on exercises and lifestyle adjustments.
• Referrals for physical therapy or in-person specialist review if the pain does not improve with self-care.

To prevent the return of De Quervain’s, you should look at how you use your hands and wrists. Ergonomic adjustments at work—such as using a vertical mouse or an ergonomic keyboard—can make a significant difference. If you are a new parent, try to lift your baby by scooping them up under their armpits rather than using your thumbs as leverage. Regular stretching and 'micro-breaks' during repetitive tasks are also recommended by UK occupational health specialists.