De Quervain's Tenosynovitis

This page has been designed to provide you with the right information about De Quervain’s tenosynovitis and the rehabilitation that may help you in your recovery.

What is De Quervain’s tenosynovitis?

Firstly, De Quervain’s tenosynovitis is not a dangerous issue. It normally relates to pain around the base of the thumb.

a human hand performing the thumbs up gesture on white background.

You haven’t explained what it is yet!

You’re right, we haven’t!

De Quervain’s tenosynovitis relates to an irritation of one or more of the tendons (which attaches muscle to bone) around the base of your thumb. These tendons help move the thumb and pass through a small tunnel (synovial sheath) as they enter the base of the thumb. In De Quervain’s tenosynovitis, it is thought that this sheath or tunnel gets irritated, which then in turn causes the tendon to become upset.

 

What is a tendon or tendon sheath and why are mine irritated?

A tendon is a normal part of your anatomy. Their main job is to connect muscle to bone so that when your muscle contracts (works), it passes the force (or energy) to the tendon and then to the bone, which creates movement. The tendons involved in De Quervain’s tenosynovitis are slightly special, as they pass through a sheath or tunnel of tissue called synovium as they pass into the base of the wrist. The purpose of the sheath is to add protection, lubrication and help keep the tendons working at their best.

Tendons are incredibly strong and robust things. This means they are designed to work hard and they normally do this without any issues. Just like any other body part, they can be trained to work harder if you need them to (i.e. by lifting weights or doing your job) but equally, they can become less efficient at doing their job if you don’t use them.

Tendon irritation can be caused by many things, but in a lot of cases it is normally caused by one of the following:

1. Doing more than you are used to

2. Doing something new or different that you are not used to

3. Doing either of the two things above but having a period (sometimes a long time) of doing less before

OK, so what happens to the tendon/sheath?

If you think of your tendons as being really good at doing their job (passing the energy from the muscle to bone to create movement), it means they can put up with a lot of work when they need to. If you find yourself doing more than you are used to, doing something you are not used to doing or more importantly, having a period of doing less activity before, then you can push your tendon’s ability to cope. Most of the time you notice very little, maybe a bit of an ache here and there, but sometimes your tendons can react and say “I’m struggling”.

If this happens, you will normally notice some discomfort and may find that moving can be uncomfortable. Think of this as your tendon being an ‘unhappy worker’, now struggling to do its normal day job and complaining about the work it has to do. Most of the time the soreness will settle with time, but sometimes it can last a bit longer, maybe into weeks or months.

 

So, what are the common symptoms of De Quervain’s tenosynovitis?

In most cases, De Quervain’s tenosynovitis results in discomfort (and possibly swelling) around the base of the thumb.

People with De Quervain’s tenosynovitis often find that gripping, twisting the forearm/hand or carrying/lifting things will be sore.

 

Ok, I think I might have De Quervain’s tenosynovitis - what can I do about it?

Firstly, you should know that it is possible to feel better. Sometimes, these issues can be really quite sore and can get in the way of things that you would normally take for granted, making you feel that you’ll never get better. However, most cases of De Quervain’s tenosynovitis will get better by themselves over time. If it hasn’t settled by itself then physiotherapy can help.

Understanding the issue is often the best place to start. Reading the information above can help you better understand that De Quervain’s tenosynovitis is not a damaging or dangerous problem and that it can get better.

Secondly, there are two important things that can help you on your recovery journey:

1. Calm the problem down

2. Build yourself back up again

What does ‘calm the problem down’ mean?

If you think back to the idea that your irritated tendon is an unhappy worker, then if you keep asking your tendon to do the same job, in the same way that it always has, then the tendon will keep being sore. In other words, when something is sore, think of it as your tendons saying, “I can’t do that as easily as I used to right now”. Making some changes to the things that are sore may help calm the issue down to then allow you to move on with your recovery. Think of it as putting the tendon on lighter or amended duties whilst it’s sore.

We have written a whole page on ‘calming things down’ and called it ‘Load Management'. You can find it here along with some homework to try to help your wrist’s recovery: Load Management

 

Can you give some examples of what you mean?

Sure, but remember everyone is different and you will have to do some thinking yourself around how your wrist is affecting you and some of the changes you might need to make.

 

Things that are sore Why is it sore? Possible solution

Gripping
Sore tendons will find hard work challenging		 Try not to grip too hard or tightly or use your other hand if you can

Lifting
Sore tendons will tire more quickly and will find hard work more challenging		 Reduce how much you are lifting or change the way you lift i.e. hand facing in or up. Use your other hand if possible

Typing or writing
Sore tendons will tire more quickly
Try to take more regular breaks or gentle exercises throughout the day

Pressure on the wrist
Sore tendons don’t like pressure
Don’t press it!

 
So, should I just rest it and do nothing?

No, this is not what we are trying to say.

Firstly, it is impossible to completely rest your wrist as you still have everyday tasks to complete like brushing your teeth, making a cup of tea and working etc.

Secondly, completely resting your wrist may temporarily ease the symptoms, but it will not address the underlying cause. If you simply rest and make no other changes (such as looking at the things that make your wrist sore and completing the exercises set out below), then you are unlikely to progress as well or as quickly as you might like.

How long should I work on ‘calming things down’?

This is a little tricky to be specific about and it is probably best to think about what your wrist is saying. If you have been really good at adjusting, modifying and looking at the things that make your wrist sore, then you should notice some changes within a few short weeks.

Is there anything else that can help ‘calm it down’?

Some people will find the use of a thumb splint (often called a thumb spica) can be useful to help calm their pain down. They can be issued by the physiotherapy department (you will need to be under our care for us to provide you with one) or can be bought easily online (search: thumb spica).

You should be aware that the splint should only be used temporarily, and as soon as your thumb starts to feel better, you should start to reduce how much you use it. Although splints can be useful, they can sometimes be tempting to use all the time or carry on using “just in case”. Remember, your thumb and wrist are meant to be used and therefore, the way to get the best overall recovery is to calm it down and then build it back up, rather than simply rely on a splint.

 

Ok, what do I do once it feels calmer?

Firstly, well done! Often ‘calming it down’ is the hardest part of your recovery.

Now that your wrist feels somewhat calmer, the temptation might be to start going back to your normal activities in the same way you did before your wrist issue. Sometimes this can be ok but equally, sometimes you might find that your wrist is not quite ready to return to normal just yet and may get irritated again. It might be best to think that your wrist needs to get fit and strong again in order to get back to doing normal things in normal ways.

As we’ve said before, if you consider your sore wrist as an unhappy worker, then you’ve adjusted and modified things (putting it on ‘lighter duties’) to help calm it down. Now you’ve got to start a gradual or phased return to work (or normal). Jumping in at the deep end and going back to normal might result in your wrist becoming grumpy and sore again.

OK, I know I’ve got to build it up and understand it’s got to be done in the right way, but how?

Understanding that it might take some time and that your wrist will be more likely to cope better if you do things in a gradual way, is very important as the temptation will be to rush in, especially if it’s less sore than before.

No one is the same just like no wrist problem is the same as the next, therefore there are no ‘formulas' that will be right for everyone. However, we have provided (below) an exercise programme that, if followed, can be effective to helping you move forwards with your wrist complaint.

 

 

 

Before I start, I’d like to know what the exercises are trying to do.

Excellent point, as it’s often useful to know what you’re aiming to do before you start.

Firstly, the exercises are aiming to introduce a little bit of work into the tendon by asking the muscles to do some work. The aim is to start with only a little bit of work (within what is comfortable) and not much movement.

As you move through the exercises (as your wrist allows), you will notice that the amount of work/ effort and the amount of movement increases.

Lastly, one of the most important things about all of these exercises, is they are trying to help you regain some trust in your wrist. If your wrist has been sore for some time, it is only normal to be a little cautious when you start to move back into doing things that caused you pain before. This is why the exercises are done gradually and shouldn’t be rushed too much.

 

 

What should I expect with these exercises? Will they be painful?

This is a very important question.

If your wrist has been sore for some time, it would be a bit unrealistic to expect that it will be pain-free when doing these exercises. However it is important that you don’t do too much to then upset the problem all over again.

A good marker for how hard to work is that you should feel some discomfort (not too much though), but it should settle within 24 hours. If you are still obviously sore the following day, you may have done too much/ pushed too hard, therefore next time you do the exercises, reduce the effort a bit.

Dice with letters on spelling 'Comfort/ Discomfort'.

Will this get better with just adjusting the things that are sore and exercises?

Something that is reassuring about De Quervain’s tenosynovitis is that it will often get better by itself over time. As outlined above, there are a number of things that you can do to try and help your symptoms settle and, in most cases, these can be effective.

Apart from these exercises, is there anything else I can be doing to help myself?

Yes, there is and here are just a couple of the most important things:

 

Some people will choose to manage their wrist pain with pain relief, whilst some may choose to avoid medication. Applying something cold to your wrist may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

General exercise, including strengthening exercise (working against something like a weight, gravity or exercise bands) is considered one of the key treatments for most aches and pains, even if it doesn’t specifically involve your wrist.

Exercise comes in many shapes and forms and there is no ‘best’ exercise. Often it is best to think of the most effective exercise is the one you enjoy and will actually do. Current recommendations on exercise and how often we should be looking to do it can be found here; Understanding Exercise

We have included a series of exercises at the bottom of the page that will be able to help you move forwards with managing your wrist complaint.

Weight loss is recommended as something that is important for the management of most muscle and bone issues. Losing weight is difficult and we understand that.

You may be thinking “how is losing weight going to help my wrist?” and it would be a good question if you were thinking it. Often people will think that simply putting more weight through their joints is the reason why they get problems and being closer to their ideal body weight will simply stop their symptoms. Unfortunately, it isn’t that easy. It is worth knowing that fat cells are very active cells and one thing they do is the produce chemicals that can affect your pain sensitivity (Tashani et al, 2017).

By looking at diet, exercise, sensible goal setting and establishing a good support network, a weight loss journey is more likely to succeed and the benefits to your wrist are more likely to be influenced by the journey you take to lose weight rather than being lighter.

If you would like some support to help you with your weight loss journey, please contact our partners at Feel Good Suffolk or Active Norfolk.

Getting the best out of your diet is important to support your training programme. There are lots of different opinions on what is best but generally it is agreed that if you want to build muscle, you should look to increase the protein in your diet. 1.5 grams of protein to every kilogram of your body weight is often suggested as a good starting point. More advice about diet can be found here: https://www.nhs.uk/live-well/eat-well/food-and-drinks-for-sport/

Sleeping well will help your recovery and support your training programme. More advice about sleeping better can be found here: https://sleepcouncil.org.uk/advice-support/

Frequently asked questions

 

A: A steroid injection for De Quervain’s tenosynovitis is an option however, like most drugs, steroids come with side-effects and some of these can cause problems in the future for your wrist (particularly the tendons). In a recent review article, Abi-Rafeh et al. (2020) suggested that corticosteroid injections for De Quervain’s tenosynovitis may be of benefit in the short-term, but the amount of high quality clinical research available to review makes it difficult to draw any firmer conclusions. In other words, an injection may help in the short-term, but most tendon issues recover best with adjusting the things that are sore and graded exercises as outlined in this information page.

A: Scans (MRIs or ultrasound scans) are very useful in a lot of cases. However, they are not normally needed for the assessment or management of most wrist issues. If your GP or physio decides they would like to arrange a scan for you, it is likely they are checking for something in particular, but the treatment (outlined above) remains the same and the most effective way of managing De Quervain’s tenosynovitis.

A:  Often people will make a better recovery if they are able to remain at work rather than take time off sick. As mentioned before, the best way to approach your wrist issue is to adjust the things that are sore (including work and sport) and when you are ready, try to work the tendons ‘better’ with exercises.

A: Firstly, ask yourself if you tried the ‘calm it down’ approach first. If you didn’t, then that might be the reason why you haven’t moved forwards. If you have, ask yourself if you did everything you could do and really commit yourself to adjusting/modifying all the things your wrist was telling you it was struggling with.

A: Often these types of problems take a long time (weeks into months) to settle, so be patient with yourself. If you have been dedicated to the ‘calm it down’ work and the exercises, as well as being patient and giving it time and still you feel no better, do discuss this with your physio as they may be able to discuss other options with you.

Exercise ideas:

These are our top exercises for Dequervain’s tenosynovitis and have been chosen for you to start your rehabilitation.

Aim to complete one or both of these little and often throughout the day.

It is like that you will feel some discomfort when you are exercising your thumb (or afterwards), but this should improve with time.

Need more help? Refer yourself here.

References:

Buchanan, B.K. & Kushner, D. (2020) Plantar fasciitis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/ (last accessed 18/01/2021)

Rathleff, M.S.,  Mølgaard, C.M.,  Fredberg, U.,  Kaalund, S.,  Andersen, K.B.,  Jensen, T.T., Aaskov, S., and Olesen, J.L. (2015). High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medical Sports Science: 25: e292–e300 doi: 10.1111/sms.12313 (accessed 18/01/2021).

Tashani, O.A., Astita, R., Sharp, D. & Jonhson, M.I. (2017). Body mass index and distribution of fat can influence sensory detection and pain sensitivity. European Journal of Pain. 21(7):1186-1196.

 doi: 10.1002/ejp.1019 (accessed 16/12/2020).