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

De Quervain’s tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. Tendons are tough cords of tissue that connect muscle to bone. In the thumb, these tendons run through a small tunnel (sheath) at the wrist. When the sheath becomes inflamed or thickened, it constricts the tendons, making movement painful and difficult.

In the UK, this condition is often associated with repetitive strain injuries (RSI). It is commonly seen in people who perform repetitive hand or wrist motions, such as office workers, manual labourers, and new parents. The latter has led to the colloquial term 'mummy thumb,' as the repetitive lifting of an infant can strain these specific tendons.

The primary symptom of De Quervain’s tenosynovitis is pain or tenderness at the base of the thumb or the side of the wrist. You may notice:

• Pain that worsens when moving the thumb or wrist, especially when gripping or twisting.
• Swelling near the base of the thumb that may be accompanied by a fluid-filled cyst.
• A 'snapping' or 'catching' sensation when moving the thumb.
• Difficulty performing tasks that require a pinching motion.

If left untreated, the pain may spread further up the forearm or down into the thumb. According to NHS guidance, early intervention is key to preventing the condition from becoming chronic.

While the exact cause isn't always clear, De Quervain’s is almost always linked to chronic overuse of the wrist. Repetitive movements, such as typing, gardening, or playing racket sports, can irritate the tendon sheath. Other risk factors include:

• Age: It is most common in adults aged 30 to 50.
• Sex: The condition is more prevalent in women.
• Pregnancy: Hormonal changes and fluid retention during pregnancy can increase the risk, alongside the physical strain of lifting a baby.
• Inflammatory conditions: People with rheumatoid arthritis may be more susceptible to tenosynovitis.

Diagnosis usually involves a physical examination by a healthcare professional. A common clinical tool used is the Finkelstein test. During 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 sharp 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 suspects a bone fracture or osteoarthritis, as De Quervain's is a soft tissue issue.

The goal of treatment is to reduce inflammation and preserve thumb movement. NICE (National Institute for Health and Care Excellence) suggests a stepped approach:

Self-Care and Activity Modification

The first step is avoiding the activities that triggered the pain. Applying ice packs to the affected area for 15 minutes several times a day can help reduce swelling.

Splinting

A 'thumb spica' splint is often recommended. This keeps the thumb and wrist in a neutral position, allowing the tendons to rest and the inflammation to subside. These are widely available at UK pharmacies or via a GP referral.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can manage pain and swelling. Always consult a pharmacist or doctor before starting new medication to ensure it is appropriate for you.

Physiotherapy

A physiotherapist can provide specific exercises to strengthen the muscles and improve the gliding of the tendons within the sheath.

If self-care measures like rest and icing do not improve your symptoms within two weeks, you should speak to a GP online or in person. An online GP consultation is a convenient way to discuss your symptoms, receive a diagnosis, and get a management plan without leaving home.

An online doctor can:

• Assess the severity of your wrist pain through a video consultation.
• Provide advice on the correct type of splint to purchase.
• Issue a private prescription for stronger anti-inflammatories if required.
• Provide a sick note if your condition prevents you from performing your work duties, particularly for manual or computer-heavy roles.
• Discuss referral pathways for steroid injections or physiotherapy if conservative treatments fail.

If symptoms are severe or persistent, a GP may suggest a corticosteroid injection into the tendon sheath. This is highly effective at reducing swelling and provides long-term relief for many patients. In rare, recalcitrant cases where nothing else works, a minor surgical procedure may be performed to open the sheath and give the tendons more room to move.