Home / Conditions / De Quervain's tenosynovitis
Two tendons run to the thumb through a tight tunnel at the edge of the wrist. When that tunnel becomes inflamed, lifting anything with the thumb out to the side hurts.
De Quervain's tenosynovitis — also written de Quervain syndrome — is one of three common reasons the thumb side of the wrist hurts, and they sit within a couple of centimetres of each other. Pointing to the exact sore spot separates them faster than any test.
| De Quervain's the tendon sheath | Thumb base arthritis the joint | Scaphoid fracture the bone | |
|---|---|---|---|
| Tender exactly where | Over the tendons, above the wrist crease | At the joint, in the web below the thumb | In the hollow at the thumb's base |
| What provokes it | Lifting and gripping with the thumb out | Pinching, opening jars, turning keys | A fall onto an outstretched hand |
| How it started | Gradually, over weeks | Gradually, over years | Suddenly, at a moment you remember |
| What you can see | A firm swelling over the tendons | The joint squaring off | Swelling, sometimes bruising |
| Grinding the joint | Not painful | Painful and gritty | Not the point of tenderness |
| X-ray | Normal — usually not needed | Shows the joint wear | Can look normal at first |
Two less common ones worth knowing. Pain higher up, a few centimetres along the forearm, sometimes with a creaking you can feel, points to intersection syndrome rather than de Quervain's. Numbness or tingling over the back of the thumb, without pain on moving it, points to the skin nerve that runs across the same area being irritated — often by a tight watch strap.
Two tendons — one that pulls the thumb away from the hand, one that straightens it — run side by side through a tunnel at the edge of the wrist. The tunnel is lined with a sheath that lets them glide. Repeated loading thickens that lining, the tunnel stops being big enough, and every thumb movement drags.
What a picture rarely shows is that the tunnel is not always a single space. In a good proportion of people a thin wall divides it, giving each tendon its own compartment. That matters twice over: an injection placed in one side may never reach the other, and an operation has to open both or the problem continues.
It also explains why this is so common after a baby arrives. Lifting a child under the arms holds the thumb out and loads both tendons at once, many times a day, for months.
A note on the test. The version often described — tucking the thumb into the palm, closing the fingers over it and bending the wrist — is a different manoeuvre, and it stretches enough structures to hurt in wrists that are perfectly normal. Holding the thumb itself is the more specific test, which is why the finding is always read alongside where the tenderness actually is.
Most people settle without an operation. The two things that matter most are taking the load off the thumb and using the right kind of splint.
It needs to hold the thumb as well as the wrist — the type with a channel the thumb sits in. A plain wrist splint from a pharmacy leaves the thumb free to keep pulling on the inflamed tendons, which is the commonest reason splinting seems not to work. Alongside it, changing how you lift: scooping under rather than gripping with the thumb out.
A short course of anti-inflammatory medication, and ice over the sore area after the activities that provoke it. Useful while the load comes off, rather than a treatment on its own.
An injection into the sheath works particularly well in this condition and settles many wrists for good. Where one does not help, the dividing wall inside the tunnel is a common explanation — the injection reached one compartment but not the other — and a second, differently placed injection may be worth trying before anything else.
A release opens the roof of the tunnel so the tendons are no longer squeezed. It is a small day procedure under local anaesthetic, and it is decisive when the non-surgical steps have not worked. Both compartments are checked and opened where a dividing wall is present. The skin nerve to the back of the thumb crosses this exact spot, which is why the incision is planned carefully and why numbness there is the main thing discussed beforehand.
Lifting a child under the arms holds the thumb out to the side and loads both tendons at once, dozens of times a day. Hormonal changes around pregnancy and feeding add some fluid retention around the sheath. It is common enough that it has a nickname, and it usually settles once the load is managed.
Only if it holds the thumb. Most wrist splints sold over the counter support the wrist and leave the thumb free, which does very little here. What you want is the type with a channel that the thumb sits in.
Often, if the activity that caused it eases off. Where it does not, the reason is usually that the loading has continued, and this responds well to treatment, so there is little to gain from waiting it out.
It works well in this condition, more reliably than in most tendon problems. Where it does not, the usual explanation is a dividing wall inside the tunnel, so the injection settled one tendon and not the other. That is a reason to try again differently rather than to give up on it.
No. Arthritis is wear in the joint at the base of the thumb, and it is painful when the joint is pinched or ground. This is inflammation of the tendon sheath above the joint. The sore spots are in different places and the treatments differ.
No. Bring any scan or X-ray reports, and any splint you have been using, so it can be checked that it is the right type.
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Be ready to point to the sorest spot, and bring the splint if you have one. Those two things answer most of the question.
