De Quervain’s Syndrome

The cause of De Quervain’s is poorly understood. The condition is often attributed to occupational or repetitive activities involving extending the thumb and may occur following minor injury or from overusing your thumb or wrist such as gardening, DIY, or use of a gaming console.

De Quervain’s is most common among women between the ages of 30 and 50 and mothers of small babies seem particularly prone to it, but whether this is due to hormonal changes after pregnancy or due to lifting the baby repeatedly is not known.

Anatomy

Tendons are rope-like structures that attach muscle to bone. They are covered by a slippery thin, soft-tissue layer called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath.

Two of the main tendons to the thumb (extensor pollicis brevis and abductor pollicis longus) pass through a soft-tissue tunnel (retinaculum) located on the thumb side of the wrist.

Tendinosis is a name given to tendons that show chronic (long-term) degeneration and thickening. The main problem is failed healing of repeated minor injuries rather than inflammation.

Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.

De Quervain’s disease is therefore a set of symptoms which results from tendon degeneration, not inflammation as was previously believed to be the case.

Symptoms of De Quervain’s include:

• Pain & tenderness near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
• A “sticking” or “stop-and-go” sensation in your thumb when moving it

If the condition goes too long without treatment, the pain may spread further into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

De Quervain’s can usually be diagnosed based on the typical site and nature of the symptoms described above.

The diagnosis can be confirmed using a simple test called a Finkelstein test, in which you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have De Quervain’s disease.

Imaging tests, such as X-rays, generally aren’t needed to diagnose De Quervain’s disease.

Selfcare

Most of the symptoms associated with De Quervain’s will settle with rest and the correct changes to activity. Thumb movements such as gripping/pinching may worsen symptoms, so stopping the aggravating activities will help to settle the inflammation and pain.

Change your actions to reduce the stress on your wrists and take frequent breaks to rest if you are using your wrist a lot. Avoid repetitive and sustained wrist movements, particularly where the wrist is bent towards the palm and the thumb is spanning widely.

For new mums this may mean trying alternative ways of lifting your baby without scooping up under the arms and if finding bottle feeding painful try a bottle with a handle. If breastfeeding, try to relax your thumb and wrist once you have positioned your baby. Avoid steering a pram one handed, this is very stressful for your wrist.

Swelling and pain can also be eased by applying an ice pack/frozen peas wrapped in a damp cloth for 10-15 minutes at a time, 3 times a day to the area.

• Please note only use ice if you have normal skin sensation
• Check the skin regularly
• Stop if there is excessive pain, numbness or tingling
• Do not put ice directly on to the skin as this may cause a burn

You may benefit from using a splint that immobilises the wrist and thumb. There are a number places online you can purchase a De Quervain’s splint.

There is evidence to suggest that only using the splint during painful activities can help but sometimes it is necessary to wear the splint continuously for up to 6 weeks to rest the tendons. If you do need to wear the splint continuously, please take it off a few times a day for hand hygiene and to gently exercise the wrist and thumb to prevent stiffness.

Simple painkillers

Painkillers like paracetamol will ease the pain but need to be taken regularly to control the pain. Always follow the instructions on the packet.

Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) NSAIDs are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions. However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your pharmacist or GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Physiotherapy

There is good evidence that certain exercises can help to stretch and strengthen the affected area. When done at home regularly these exercises will help to reduce pain and increase function. If in doubt, consult a local physiotherapist to find out which exercises may benefit you and how to perform them safely.

This leaflet from NHS Wales describes some helpful exercises: De Quervain’s Disease (.pdf patient information leaflet including specific exercises)

Steroid Injections

Under local treatment guidance, steroid injection should be considered if symptoms have persisted for more than a month despite the use of the conservative measures listed above.

A steroid injection into the tendon sheath relieves the pain in about 70% of cases. The risks of injection are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection. Usually, you need to be referred to a hospital specialist to have this done.

Surgical decompression

The goal of surgery is to open the thumb compartment (covering) to make more room for the irritated tendons (“decompression”).

Surgical decompression is generally reserved for the most severe/persistent cases; however, pain relief is usually rapid. The procedure is performed under local (into the skin at the site of the pain) or regional (into the armpit to numb the entire arm) anaesthetic. The scar may be sore and unsightly for several weeks. Because the nerve branches are gently moved to visualise the tunnel, temporary numbness can occur on the back of the hand or thumb. Other risks are the risks of any surgery such as infection (less than one in 100 risk) or stiffness.

You should consult your GP if you’re still having problems with pain or function after you’ve tried:

• Not using your affected thumb
• Applying cold to the affected area
• Using over the counter painkillers such as paracetamol and ibuprofen

Under local treatment guidance, steroid injection should be considered if symptoms have persisted for more than a month despite these conservative measures. Usually, you need to be referred to a hospital specialist to have this done.

Orthopaedic referral to consider surgery may be advised if symptoms persist for more than 4 months despite trying all the above measures.

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

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If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

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