De Quervain's Tenosynovitis
Written by Md. Kamruzzaman
Medical Technologist | Diploma in Physiotherapy
On This Page
What is De Quervain's tenosynovitis?
Why is it called "Mommy's Thumb"?
What I see in the clinic
Which tendons are affected?
Does De Quervain's affect a nerve?
Causes and risk factors
Symptoms
What makes it worse?
How is it diagnosed?
About the Finkelstein test
Can De Quervain's cause permanent damage?
How I treat De Quervain's in my clinic
Physiotherapy for De Quervain's
Exercises for De Quervain's
How to reduce your risk
When to see a healthcare professional
Frequently asked questions
Final thoughts
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| De Quervain’s Tenosynovitis: Causes, Symptoms, Treatment & Physiotherapy |
1. What Is De Quervain's Tenosynovitis?
One of the most common patients I see in my clinic is a new mother. She comes in holding her baby in one arm and her wrist in the other hand. She tells me the pain started a few weeks after delivery, and now she can't even lift her baby without wincing.
The diagnosis is almost always the same: De Quervain's tenosynovitis.
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. These tendons help move the thumb away from the hand and assist with thumb movement.
The affected tendons pass through a narrow tunnel near the wrist. Irritation and thickening of the tendon sheath can make tendon movement painful—particularly during gripping, pinching, lifting, or twisting movements.
Pain is usually felt around the base of the thumb and may sometimes extend toward the forearm.
What I tell my patients: The good news is that most people recover without surgery. But the sooner you start treatment, the easier it is to fix.
2. Why Is It Called "Mommy's Thumb"?
De Quervain's tenosynovitis is sometimes called "Mommy's thumb" because it commonly occurs in people who have recently had a baby.
New parents may repeatedly lift, hold, feed, or care for an infant—increasing the amount of gripping and thumb movement they perform. Pregnancy and the period after childbirth may also be associated with this condition.
However, De Quervain's is not limited to mothers. It can affect anyone who performs repetitive thumb and wrist activities.
3. What I See in the Clinic
De Quervain's is often called "Mommy's Thumb" because new mothers are so commonly affected. But I want to be clear: I see this condition in many different people.
In my experience, the most common groups are:
- New mothers who lift and hold their babies constantly
- People whose jobs involve repetitive gripping (chefs, hairdressers, factory workers)
- People who started a new hobby involving their hands (gardening, racquet sports, climbing)
- People over 40, in whom the tendon sheath naturally thickens
The pattern is always the same: pain on the thumb side of the wrist, worse with gripping, pinching, or twisting. Some people feel a clicking sensation. Others just feel a deep ache that won't go away.
What I tell my patients: This isn't your fault. Whether it's lifting your baby or gripping tools all day, the tendon sheath has become irritated. The good news is that we can almost always help.
4. Which Tendons Are Affected?
There are two tendons involved in De Quervain's. You don't need to memorize their medical names—what matters is that they both pass through a narrow tunnel on the thumb side of your wrist.
When that tunnel gets irritated or thickened, the tendons can't glide smoothly, and every movement of your thumb becomes painful.
Think of it like a rope passing through a tight ring. If the ring swells, the rope can't slide freely. That's what's happening in your wrist.
(For medical reference: the two tendons are the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).)
5. Does De Quervain's Affect a Nerve?
No. De Quervain's tenosynovitis is primarily a tendon and tendon-sheath problem, not a nerve disorder.
Occasionally, irritation around the wrist can be associated with symptoms such as tingling or numbness, but these are not the main features of De Quervain's. If significant numbness or weakness is present, another condition should also be considered.
6. Causes and Risk Factors
The exact cause of De Quervain's is not always clear. However, several factors may increase the likelihood of developing symptoms.
1. Repetitive thumb and wrist movements
Repeated gripping, pinching, twisting, or lifting can irritate the tendons. Examples include
- Repetitive work with the hands
- Gardening
- Using hand tools
- Racquet sports
- Rock climbing
- Repeated lifting
- Caring for a baby
- Activities involving frequent thumb movement
2. Sudden increase in activity
Starting a new sport, job, hobby, or exercise routine that places greater demands on the thumb and wrist may trigger symptoms.
3. Pregnancy and after childbirth
De Quervain's can occur during pregnancy or after childbirth. Hormonal changes and changes in hand and wrist activity may contribute.
4. Wrist or thumb injury
A direct injury or strain around the thumb-side wrist can contribute to irritation of the affected tendons.
5. Inflammatory conditions
Some inflammatory conditions, including rheumatoid arthritis, may be associated with problems affecting the wrist and hand.
Important: Not every person with De Quervain's has a specific identifiable cause.
7. Symptoms of De Quervain's Tenosynovitis
Common symptoms include:
- Pain on the thumb side of the wrist
- Tenderness near the base of the thumb
- Swelling around the wrist or thumb
- Pain when gripping or pinching
- Pain when lifting objects
- Difficulty moving the thumb
- Pain when twisting the wrist
- Difficulty opening jars or handling objects
- Pain that may extend toward the forearm
- Clicking, snapping, or grating sensations in some people
Symptoms often become worse when the thumb and wrist are repeatedly used.
8. What Makes De Quervain's Worse?
Activities that repeatedly load the thumb and wrist can aggravate symptoms. For example:
- Repeated gripping
- Pinching
- Twisting
- Lifting heavy objects
- Holding a baby with the wrist in an awkward position
- Repetitive hand movements
- Continuing an activity despite increasing pain
During a painful phase, reducing aggravating activities can help the irritated tissues settle.
9. How Is De Quervain's Diagnosed?
Diagnosis is usually based on your symptoms and a physical examination.
A healthcare professional may:
- Ask when the pain started
- Ask about work, sports, childcare, or other repetitive activities
- Examine the thumb and wrist
- Check for tenderness and swelling
- Assess thumb and wrist movement
- Perform a clinical test such as the Finkelstein test
Imaging is not usually necessary, although it may sometimes be used when another condition needs to be ruled out.
10. About the Finkelstein Test
The Finkelstein test is a clinical examination used to reproduce pain associated with De Quervain's.
It is better performed by a trained healthcare professional rather than repeatedly testing yourself, because deliberately forcing a painful wrist position can aggravate symptoms.
What I tell my patients: Don't keep testing yourself to see if it still hurts. You're just irritating the tendon. Let a professional assess it.
11. Can De Quervain's Cause Permanent Damage?
De Quervain's can be painful and may interfere with normal activities if symptoms persist.
However, it is not appropriate to say that De Quervain's normally causes permanent damage. Many people improve with appropriate conservative treatment, activity modification, splinting, and rehabilitation.
If pain continues or daily activities become difficult, a healthcare professional should assess the condition.
12. How I Treat De Quervain's in My Clinic
Treatment depends on the severity and duration of symptoms. Here's what I actually recommend:
1. Activity Modification — The First and Most Important Step
But I don't tell patients to stop using their hands. Instead, I teach them a new way to move.
For example, I tell new mothers: don't lift your baby with your thumbs underneath. Use your whole hand and forearm instead. Small changes like this can make a huge difference.
2. Thumb Spica Splint
I recommend a splint for most of my patients, especially in the early stages. It restricts painful thumb movement and gives the tendon a chance to rest.
I usually recommend wearing it during activities that cause pain, but not all day — because we don't want your wrist to get stiff.
3. Cold Therapy
For the first few days after symptoms start, I tell patients to use a cold pack wrapped in a towel for 10–15 minutes, a few times a day. Never put ice directly on the skin.
4. Pain-Relieving Medication
Some people may benefit from pain-relieving or anti-inflammatory medication. NSAIDs like ibuprofen can help with pain and inflammation.
Important: Ask a doctor or pharmacist which option is appropriate for you — especially if you have other health conditions, are pregnant, or take other medications.
5. Physiotherapy
This is where I spend most of my time with patients. My job isn't just to give you exercises — it's to figure out why your tendons are irritated and to help you change how you use your hand.
I look at how you lift, how you grip, how you hold your baby. Small changes in technique often work better than any exercise.
6. Corticosteroid Injection
If conservative treatment isn't working after a few weeks, I refer patients to a doctor for a steroid injection. In my experience, this works very well for many people — often within a few days. But it doesn't work for everyone, and some patients need more than one injection.
7. Surgery
Surgery is the last resort, and in my experience, most patients don't need it. But if symptoms persist despite everything else, surgery to release the tight tunnel can be very effective. Recovery is usually quick.
13. Physiotherapy for De Quervain's Tenosynovitis
Physiotherapy can be useful as part of conservative management — particularly when symptoms are affecting hand function or when the person needs help returning safely to normal activities.
The exact rehabilitation programme depends on your symptoms and stage of recovery.
Main Goals of Physiotherapy
- Reducing pain
- Improving comfortable thumb and wrist movement
- Modifying aggravating activities
- Restoring strength gradually
- Improving hand function
- Helping prevent recurrence
14. Exercises for De Quervain's Tenosynovitis
Here's what I actually teach my patients. But remember: these are general guidelines. Your specific exercises should be tailored to your condition by a therapist who has assessed you.
1. Gentle Thumb Range of Motion
Move your thumb slowly in a circle, then up and down, and side to side. Do it gently, in a comfortable range. Stop if you feel sharp pain.
How often: 5–10 times, 2–3 times a day.
2. Isometric Thumb Press
Press your thumb against your other hand without actually moving it. Hold for 5 seconds.
Why: This helps maintain strength without irritating the tendon. I usually introduce this after the acute pain has settled.
3. Gentle Wrist Stretch
Extend your arm, palm down, and gently bend your wrist toward the floor. Hold for 15–20 seconds.
Important: I only recommend this when the acute phase has passed. Stretching too early can make it worse.
4. Gradual Grip Strengthening
Once you can grip without pain, use a soft stress ball. Squeeze gently, hold for 3–5 seconds, release. Start with just a few repetitions and build up slowly.
What I tell my patients: If an exercise makes your pain worse, stop. The goal is to gently restore movement, not to push through pain. Do not copy an exercise programme simply because it appears online.
15. How to Reduce Your Risk of De Quervain's
Some practical strategies include:
- Avoid sudden increases in repetitive hand activity
- Take regular breaks during repetitive tasks
- Keep the wrist in a comfortable, neutral position when possible
- Avoid prolonged forceful gripping
- Use both hands when lifting heavier objects
- Modify baby-care techniques if lifting or holding your baby causes pain
- Gradually increase exercise or work demands
- Seek professional advice if pain persists
16. When to See a Healthcare Professional
Consider getting professional assessment if:
- Pain persists despite reducing aggravating activities
- Pain interferes with work or daily activities
- Swelling continues or increases
- You have significant weakness
- You have numbness or tingling
- You experienced an injury before the symptoms began
- Symptoms are becoming progressively worse
Persistent thumb or wrist pain can have several possible causes, so self-diagnosis is not always reliable.
17. Frequently Asked Questions
Is De Quervain's tenosynovitis the same as arthritis?
No. De Quervain's primarily affects tendons and the tendon sheath on the thumb side of the wrist. Arthritis affects joints.
Is De Quervain's only a problem for new mothers?
No. Although it can occur during pregnancy or after childbirth, anyone can develop it.
Can De Quervain's go away on its own?
Yes, especially in mild cases. But I've seen many patients wait too long, hoping it would pass. If it's not better in 2–3 weeks, get it checked.
Should I exercise if I have De Quervain's?
Gentle movement, yes. Aggressive exercise, no. In the early stages, the goal is to calm the tendon down, not to strengthen it. Once the pain has settled, we start gentle strengthening.
Is surgery always necessary?
No. In my experience, most patients improve with conservative treatment — splinting, activity modification, and physiotherapy. Surgery is for the cases that don't respond to anything else.
18. Final Thoughts
De Quervain's tenosynovitis can be painful and frustrating — especially for new mothers who are already exhausted. But I want you to know: in my experience, most people recover without surgery.
The key is to modify your activities early, use a splint when needed, and work with a physiotherapist who can help you change how you use your hand.
Don't ignore the pain. The earlier you get help, the easier it is to treat.
Medical Disclaimer: This article is based on my experience as a medical technologist in physiotherapy and is for general educational purposes only. It does not replace an individual medical assessment, diagnosis, or treatment plan from a qualified healthcare professional. If you have persistent thumb or wrist pain, consult a qualified healthcare professional.
About the Author:
Md. Kamruzzaman is a Medical Technologist with a Diploma in Physiotherapy. Through Active Life Therapy, he shares educational information about physiotherapy, physical health, mobility, common musculoskeletal conditions, and healthy living.
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