De Quervain’s Tenosynovitis: Symptoms, Causes and Treatment in the UK

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 whenever you turn your wrist, grasp anything, or make a fist. While the exact cause is not always clear, it is classified as a repetitive strain injury (RSI) involving the thickening of the sheath that surrounds the abductor pollicis longus and extensor pollicis brevis tendons.

In the UK, this condition is frequently seen in primary care, often nicknamed 'mother's thumb' or 'gamer's thumb' due to the specific repetitive motions that trigger it. According to NICE (National Institute for Health and Care Excellence) guidelines, management typically begins with conservative measures to reduce inflammation and allow the tendons to glide smoothly again.

The main symptom is pain or tenderness at the base of the thumb, which may radiate up the forearm. You might notice:

• Swelling: Visible puffiness at the base of the thumb, near the bony part of the wrist (radial styloid).
• 'Snapping' Sensation: A feeling that the thumb is catching or clicking when you move it.
• Reduced Grip Strength: Difficulty pinching or holding heavy objects like a kettle or a frying pan.
• Increased Pain with Activity: The pain usually worsens when using the hand and thumb for repetitive twisting or gripping.

If left untreated, the pain may spread further into the thumb or back up the forearm, making simple daily tasks like buttoning a shirt or typing difficult.

Chronic overuse of the wrist is the most common culprit. When you repeat a certain motion day after day, it irritates the sheath around the two tendons, causing thickening and swelling that restricts movement.

Risk Factors

• Age and Sex: It is more common in women and individuals aged between 30 and 50.
• Pregnancy and Early Parenthood: Hormonal changes during pregnancy can cause fluid retention and ligament laxity. Additionally, the repetitive motion of lifting a newborn (using thumbs as leverage) is a frequent trigger.
• Occupational Hazards: Jobs involving repetitive typing, assembly line work, or use of handheld tools.
• Hobbies: Racket sports, golf, and intensive gaming are known contributors.
• Inflammatory Conditions: People with rheumatoid arthritis are at a slightly higher risk.

A GP or online doctor can usually diagnose De Quervain’s tenosynovitis through a physical examination and history of your symptoms. The most common diagnostic tool is the Finkelstein test.

To perform this test, you bend your thumb across the palm of your hand and fold your fingers over your thumb. You then bend your wrist toward your little finger. If this causes significant pain on the thumb side of your wrist, it is a strong indicator of De Quervain’s tenosynovitis. Imaging like X-rays are rarely needed unless the doctor wants to rule out other conditions like osteoarthritis at the base of the thumb.

The goal of treatment is to relieve the pain caused by irritation and swelling. Following NHS guidance, the first steps usually include:

Self-Care and Lifestyle Changes

• Rest: Avoiding the repetitive motions that triggered the pain is essential for recovery.
• Ice: Applying a cold pack to the affected area for 15 minutes several times a day can reduce swelling.
• Splinting: A 'thumb spica' splint holds the thumb and wrist still, allowing the tendons to rest. These can often be purchased at UK pharmacies.

Medication

Pain relief usually involves non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (either tablets or topical gel). These help reduce both the pain and the inflammation of the tendon sheath. If symptoms are severe, a GP may discuss a corticosteroid injection into the tendon sheath, which has a high success rate in resolving symptoms.

Physiotherapy

A physiotherapist can provide specific exercises to help the tendons glide more easily and strengthen the surrounding muscles to prevent recurrence.

If you are experiencing persistent wrist pain that is interfering with your work or daily life, it is advisable to seek medical advice. Speaking to a GP online in the UK can be a convenient first step. During a video consultation, a doctor can:

• Assess your symptoms and guide you through a Finkelstein test.
• Provide a diagnosis and rule out other causes of wrist pain.
• Offer advice on the best type of splints and over-the-counter medications.
• Issue a private sick note if your condition is exacerbated by your job and you require time off to recover.
• Refer you to hand therapy or specialist services if conservative treatments fail.

Early intervention often prevents the need for more invasive treatments like surgery.