De Quervain's tenosynovitis

Symptoms of de Quervain's tenosynovitis include:

• Pain at the base of your thumb that may shoot up your forearm - the pain may be gradual or sudden. It is normally worse when your hand or wrist are in use such as when grasping or lifting objects, twisting the wrist, using scissors, or giving a 'thumbs up' sign
• Swelling over the thumb side of the wrist, which may be accompanied by a fluid-filled cyst
• Difficulty moving your thumb due to pain and swelling
• Numbness at the back of your thumb and index finger
• A squeaking sound when you move your thumb
• A 'catching' or 'snapping' sensation when you move your thumb

De Quervain's tenosynovitis sometimes occurs with no apparent cause. It is eight times more common in women, particularly in mothers of small children. This may be due to pregnancy hormones, or repetitive movements like picking up a baby or toddler.

You are more likely to get de Quervain's tenosynovitis if you:

• Are female
• Are over forty years of age
• Are pregnant
• Have rheumatoid arthritis
• Have a job or hobby that involves repetitive movements of your hands or wrists

Common causes include:

• Repetitive movements of the wrist and hand
• A previous wrist injury
• Hormonal changes during pregnancy

The most common cause of de Quervain's tenosynovitis is long-term overuse of your wrist and repetitive movements like playing computer games or lifting a child into a car seat.

At your first consultation, you will be seen by an orthopaedic consultant, a doctor specialising in treating bones, muscles, and joints.

Your consultant will ask you about your symptoms and perform a physical examination. They will examine your hand and wrist to check for any visible signs such as bruising, swelling, or deformity, and press firmly along the thumb side of your wrist to check for tenderness and swelling.

Your consultant may ask you to perform a test called the Finkelstein test. This is a test where you place your thumb in your palm and grasp it with your other fingers while bending the wrist towards your little finger. If you feel pain at the base of your thumb, or in your wrist and forearm, it is likely that you have de Quervain's tenosynovitis.

How is a diagnosis made?

De Quervain's tenosynovitis is normally diagnosed based on your symptoms, physical examination, and the result of the Finkelstein test. Scans such as X-rays, MRIs, or CT scans are not usually needed to diagnose de Quervain's tenosynovitis, but occasionally an X-ray or ultrasound may be used to make sure your symptoms aren't caused by another condition.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, examine your hand and wrist, provide a diagnosis, and discuss possible treatments.

Your first consultation is where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Treatment for de Quervain's tenosynovitis aims to reduce swelling and inflammation of the tendons and tendon sheath and relieve pain.

Non-surgical treatments

Non-surgical treatments are usually the first option when treating de Quervain's tenosynovitis.

These may include:

• Splints - a removable splint to immobilise your thumb and wrist is normally worn for four to six weeks
• Kinesio taping - is a method where flexible tape is used to support and stabilise joints
• Non-steroidal anti-inflammatory drugs (NSAIDs) - over-the-counter medicines like ibuprofen can be taken orally or applied to the skin as a gel or cream
• Application of heat or ice packs - can reduce swelling and relieve pain
• Activity modification - avoiding activities that involve repetitive hand or wrist movements is sometimes enough to relieve symptoms of de Quervain's tenosynovitis
• Physiotherapy or occupational therapy - may involve exercises to strengthen muscles and change the way you move your joint. Your physiotherapist may also use techniques such as electro-acupuncture to relieve pain
• Injections of corticosteroids and local anaesthetic - are injected into the tendon sheath to relieve pain and inflammation. They have a high success rate and are effective in about 70% of cases

Recovery from de Quervain's tenosynovitis

It normally takes around four to six weeks of non-surgical treatment to recover from de Quervain's tenosynovitis. If your symptoms have not improved after this time, your consultant may recommend surgery.

Surgical treatment

Surgery may be considered if your de Quervain's tenosynovitis is severe, or your symptoms haven't improved with non-surgical treatments.

Tendon release surgery aims to release the tendon sheath and ease pressure on the swollen tendons.

It is usually performed under local anaesthetic that is injected under the skin or regional anaesthetic that is injected into the armpit to numb the whole arm. In some cases, you may be given a general anaesthetic.

Tendon release surgery is normally done as an outpatient which means you can go home the same day.

During tendon release surgery:

• A small incision (cut) is made at the side of your wrist near the base of your thumb
• Your surgeon identifies the nerves in the tendon sheath and gently moves them out of the way
• The roof of the tendon tunnel is cut and any excess tissue such as scar tissue is removed. Your incision is closed, and a sterile dressing and bandage applied

Potential risks and complications of tendon release surgery

Tendon release surgery is a relatively minor procedure, but as with all surgical procedures, there is a risk of possible complications. Your consultant will discuss these with you before your surgery so that you can make an informed decision.

General risks of surgery include:

• Shock
• Blood loss
• Infection
• Blood clots
• Chest problems
• Problems passing urine (urinary retention)
• Allergic reaction to anaesthesia

Possible complications of tendon release surgery include:

• Infection
• Temporary numbness of the thumb or the back of the hand
• Joint stiffness
• Nerve damage

Recovery from tendon release surgery

After your surgery, you will have a bulky dressing or plaster on your hand and wrist for around two weeks until the wound has healed. After this, your stitches can be removed. You will need regular physiotherapy for around six to eight weeks after surgery.

When can I drive after tendon release surgery?

How soon you can drive after surgery depends on your recovery. It normally takes six to twelve weeks to heal completely after tendon release surgery. Talk to your consultant about when you can expect to drive after your surgery.

When can I go back to work after tendon release surgery?

When you can go back to work depends on the type of job you do. You should avoid heavy, manual work for around four to six weeks after your surgery. Talk to your consultant about when you can expect to go back to work after your tendon release surgery.

De Quervain's tenosynovitis is normally a temporary condition that resolves with treatment. If you don't get treatment for de Quervain's tenosynovitis it may cause your tendon sheath to burst, or permanently restrict your movement. If you have symptoms of de Quervain's tenosynovitis, see a specialist as soon as possible.

We answer some of your most commonly asked questions about de Quervain's tenosynovitis.

How do you wrap your wrist for de Quervain's tenosynovitis?

There are many videos online demonstrating how to apply Kinesio taping to your wrist to treat de Quervain's tenosynovitis. Always speak to your consultant before attempting any kind of treatment.

Does de Quervain's tenosynovitis go away on its own?

De Quervain's tenosynovitis often goes away with non-surgical treatments like wearing a splint, resting your wrist, and taking non-steroidal anti-inflammatory drugs. However, the condition is unlikely to go away on its own and can lead to complications if left untreated. If you have symptoms of de Quervain's tenosynovitis, make an appointment with a doctor.

Is de Quervain's tenosynovitis permanent?

No. With the correct treatment, de Quervain's tenosynovitis is usually a temporary condition.

Can de Quervain's tenosynovitis come back?

Yes. De Quervain's tenosynovitis can come back unless you take steps to prevent it. To help prevent your de Quervain's tenosynovitis from coming back:

• Avoid repetitive movements of the hand or wrist
• Take frequent breaks if your job or hobby involves using your hands or wrists a lot
• Wear a splint with thumb support if needed
• Continue with exercises recommended by your consultant or physiotherapist
• See a doctor as soon as possible if you experience a recurrence of your symptoms

How long does de Quervain's tenosynovitis last?

With non-surgical treatment, de Quervain's tenosynovitis normally resolves in about four to six weeks. If you have surgery for de Quervain's tenosynovitis, the recovery time varies according to factors like your age, general health, and whether there were any complications during your surgery. On average, recovery from surgery takes between six and twelve weeks.

Is de Quervain's tenosynovitis the same as carpal tunnel syndrome?

No. While the symptoms of de Quervain's tenosynovitis and carpal tunnel syndrome are similar, the conditions are quite different. De Quervain's tenosynovitis is inflammation of the tendons in the wrist close to the base of the thumb. Carpal tunnel syndrome occurs when there is compression of a nerve on the palm side of the wrist.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about de Quervain's tenosynovitis treatment, book your appointment today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. De Quervain's Tenosynovitis, OrthoInfo
2. De Quervain's Tendosynovitis, Familydoctor.org
3. De Quervain's Tenosynovitis (MSK), NHS Ayrshire & Arran
4. De Quervain's syndrome, The British Society for Surgery of the Hand
5. De Quervain Tenosynovitis, PubMed