De Quervain's

What is De Quervain's syndrome?

De Quervain's, also called De Quervain's tenosynovitis or tendinosis, is a common, painful condition affecting two tendons that run through a narrow tunnel on the thumb side of your wrist. The lining of the tunnel thickens and swells, so the tendons can no longer glide smoothly, causing pain and swelling when you move your thumb or wrist.

Symptoms of De Quervain's

The main symptom is pain on the thumb side of your wrist, which usually comes on gradually, though it can also start suddenly. The pain can travel up your forearm and is usually worse when you use your hand and thumb, especially when gripping, pinching, wringing, or lifting your thumb up, such as when hitchhiking or using scissors.

Everyday movements like turning a door handle or tap, texting, or lifting a child with your thumbs pointing upwards can also bring on the pain.

Along with pain, you might also notice:

• tenderness when you press on the painful area
• swelling on the thumb side of your wrist, sometimes with a fluid-filled lump, which you can compare with the same spot on your other wrist
• a catching, snapping or clicking feeling when you move your thumb
• difficulty moving your thumb and wrist because of the pain and swelling.

De Quervain's isn't harmful and it's safe to keep using your hand, though it can be a real nuisance. Some mild cases settle on their own within a few weeks, but for others it can take months to improve.

Causes and risk factors

In many cases, there's no obvious cause. It's strongly linked to pregnancy, the postpartum period and breastfeeding, and symptoms often appear within 4–6 weeks of having a baby.

It isn't clear whether this is due to hormonal changes after pregnancy, or to the repeated lifting and carrying that comes with caring for a new baby.

You may also be more likely to develop De Quervain's if you:

• are female, since women are around 6 times more likely to be affected than men
• are in your 30s, 40s or 50s, as this is when it's most commonly diagnosed, though it can happen at any age
• have rheumatoid arthritis
• play golf or a racquet sport, or do another activity involving repetitive wrist and thumb movements.

How is De Quervain's diagnosed?

De Quervain's is usually diagnosed from your symptoms and a physical examination, rather than with scans or tests. Your doctor or physiotherapist will ask about your symptoms, any previous injuries, and the activities you've been doing, then examine your wrist and thumb for tenderness and swelling.

You may be asked to do a simple movement test, such as tucking your thumb into your palm and bending your wrist towards your little finger, which reproduces the pain if you have De Quervain's. Your doctor may also check your arm, shoulder and neck to rule out other causes of your symptoms.

X-rays, ultrasound or MRI scans aren't usually needed, but may be arranged if the diagnosis isn't clear or to rule out other conditions.

How is De Quervain's treated?

Most people with De Quervain's improve with non-surgical treatment, and surgery is only needed in a small number of cases.

Non-surgical treatment

Simple changes to how you use your hand can often help, such as avoiding activities that bring on the pain, or adapting how you grip and use your thumb.

A removable splint that supports your wrist and thumb can ease symptoms, especially if worn at night, though the evidence for how well splints work is mixed. If you do use one, it's best to wear it only when needed, since wearing it too much can leave your thumb stiff and weak.

Applying an ice pack to the area for 15 minutes at a time, several times a day, may help reduce pain and swelling. Always wrap ice rather than putting it directly on your skin.

Pain relief such as paracetamol or ibuprofen can help, either as tablets or as a cream or gel rubbed onto the skin. Ask your pharmacist or GP for advice on what's suitable for you, and don't take more than the recommended dose.

If these steps don't help enough, a steroid injection into the tendon sheath can relieve pain. The injection carries a small risk of thinning or colour change in the skin at the injection site with long-term steroid use.

A physiotherapist can also guide you through specific exercises to help the tendons glide more easily and to strengthen the muscles in your wrist and thumb.

Surgical treatment

Surgery may be recommended if your symptoms are severe or haven't improved after around 6 weeks of non-surgical treatment. The operation aims to release the tunnel around the tendons, giving them more room to move without pain.

It's usually done under local or regional anaesthetic, sometimes a general anaesthetic. Your surgeon makes a small cut on the wrist, carefully protects the nerves that run nearby, and widens the tunnel by cutting along its roof; any thickened tissue around the tendons may also be removed.

The tunnel's roof heals back wider than before, giving the tendons enough room to move without rubbing. Pain relief is usually quick, though the scar may be sore for several weeks.

Possible risks include temporary numbness on the back of the hand or thumb, infection, stiffness and, rarely, a small painful nerve lump called a neuroma. Symptoms can also return if part of the tendon tunnel isn't fully released during surgery.

When should I see a doctor?

See your GP or a physiotherapist if your symptoms haven't improved after a few weeks of self-care, if the pain is affecting your daily activities or work, or if you're not sure the general advice here applies to your situation. If splinting, pain relief and activity changes haven't helped after around 6 weeks, ask about further options such as a steroid injection or a referral to a hand specialist.