What happens in the wrist
Two tendons responsible for moving the thumb away from the hand and straightening it run together through a narrow tunnel on the thumb side of the wrist (the first extensor compartment), over the styloid process of the radius. When they are overloaded by repetitive thumb movements combined with tilting the wrist, their sheath thickens and the tunnel becomes too tight. The tendons rub against its walls and every movement of the thumb starts to hurt.
The name “tenosynovitis” is traditional – in reality the picture is dominated by thickening of the tissues, not classic inflammation. That is why cooling and rest alone rarely solve the problem unless the way you use your hand changes.
New mums, phones and manual work
De Quervain’s tenosynovitis is especially common in women in the first months after giving birth. The load comes from lifting the baby under the arms with the thumb spread wide, holding the baby on one arm while feeding, plus the hormonal changes and swelling of the period around childbirth. The second large group is people who spend many hours a day scrolling on their phone with their thumb, or who work with their hands in renovation, in the garden or with tools.
The common denominator is simple: the thumb does a lot of repetitions while held away from the hand, and at the same time the wrist tilts from side to side. If a sudden change is added to that – the birth of a child, a new project at work, the gardening season – the tendons cannot keep up with adapting. That is why at the visit we ask exactly what changed in your day in the weeks before the pain appeared, because that is usually where the key to lasting improvement lies.
Assessment and treatment
The diagnosis is based on examination. The core is Finkelstein’s test, in which we hold the thumb and tilt the hand towards the little finger. The popular Eichhoff test, with the thumb clenched inside the fist, more often gives a false positive result, so we do not treat it as decisive. We also check the joint at the base of the thumb, because degeneration there hurts in a similar place, and if your fingers go numb, we rule out carpal tunnel syndrome.
We start treatment by taking the load off the thumb: a splint that immobilises the thumb and a change in the way you grip. As support we use kinesiotaping and soft tissue work on the forearm. Once the pain settles, we introduce exercises that gradually restore the tendons’ tolerance to load. If there is no improvement despite several weeks of this approach, we refer you to a doctor, who may consider an injection and, rarely, a procedure.
How to offload the thumb in everyday life
The biggest change comes from the way you lift your baby: with your hands flat under the bottom and back, instead of gripping under the arms with the thumb spread. It is worth holding your phone with both hands or operating it with the index finger of the other hand, and avoiding wringing and strong squeezing during housework. These small changes often achieve more than treatment at the practice alone. When feeding, it helps to support the baby’s head with a pillow instead of your hand, and to carry heavier shopping in both hands or over the forearm rather than in your fingers alone. Less pain during everyday activities can often be felt within a few days, and a clear improvement usually appears after a few weeks, although with heavy overload the recovery takes longer. If the pain lasts longer than two weeks, book a visit via the Contact page.