De Quervain's tenosynovitis

De Quervain's affects the two tendons that move the thumb away from the hand as they run through a tight tunnel on the thumb side of the wrist. With repeated use, the tendons and their lining become thickened and irritated, so they no longer glide smoothly through that tunnel and movement becomes painful. It is usually an overuse problem rather than a sign of underlying disease.

It tends to occur in people whose hands are heavily loaded by gripping, lifting or repetitive thumb activity. Common associations include:

• New parents and carers, from repeatedly lifting and supporting a baby
• Work or hobbies involving sustained gripping, pinching or wringing
• The later stages of pregnancy and the months afterwards, when hormonal and fluid changes play a part

It is more common in women and in middle age.

De Quervain's has a characteristic pattern. Features may include:

• Pain and tenderness on the thumb side of the wrist
• Pain that is worse with gripping, lifting, or turning the wrist
• Sometimes swelling in the area, or a catching sensation with thumb movement

De Quervain's can usually be recognised from the history and a simple examination of the wrist and thumb. Confirming the diagnosis helps distinguish it from other causes of wrist pain, such as arthritis at the base of the thumb.

Ultrasound can confirm inflammation of the tendons and their sheath and help guide treatment accurately. Dr Borukhson uses point-of-care ultrasound during the consultation, so the wrist can often be assessed in the same visit. You can read more on the ultrasound clinic page.

Treatment often begins with rest, activity modification, a thumb and wrist splint, and pain relief. Where symptoms persist, an ultrasound-guided injection into the tendon sheath is frequently very effective, and ultrasound guidance allows it to be placed precisely. The plan is agreed with you.

Much can be done yourself, especially early on. The aim is to settle the irritated tendons while keeping the hand working comfortably.

• Ease the load on the thumb. Spread tasks across both hands, take regular breaks from gripping or pinching, and adapt how you lift, so the strain does not fall on the thumb side of the wrist.
• A thumb and wrist splint rests the tendons, particularly overnight or during aggravating tasks.
• Simple pain relief and a short cool compress can help a flare.
• Reintroduce activity gradually as the pain eases, rather than stopping the hand altogether.

The outlook is generally good. Many people settle with these measures, particularly when the underlying load on the thumb is addressed early, and lasting problems are uncommon.

De Quervain's is rarely dangerous, but some features point away from it and deserve prompter attention. Arrange a more urgent review if you notice:

• Spreading redness, heat, fever or rapidly worsening swelling, which can suggest infection
• Pain following a fall or forceful injury to the wrist, where a fracture should be excluded
• New numbness, pins and needles or weakness in the hand, suggesting nerve involvement rather than simple tendon irritation, as in carpal tunnel syndrome

Routine review is sensible when thumb-side wrist pain is not settling with splinting and activity change after a few weeks, when it disturbs sleep or daily tasks, or when the diagnosis is uncertain. Treating it before it becomes long-standing gives the best results.

De Quervain's usually responds well to treatment, particularly when addressed before it becomes long-standing. If you have pain on the thumb side of the wrist that is not settling, a specialist review, with ultrasound where helpful, can confirm the cause and offer effective treatment.

How is De Quervain's tenosynovitis diagnosed?

It can usually be recognised from your history and a simple examination of the wrist and thumb, sometimes including a gentle movement test that reproduces the pain. Confirming the diagnosis helps tell it apart from other causes of wrist pain, such as arthritis at the base of the thumb. Ultrasound can show inflammation of the tendons and their sheath, and Dr Borukhson uses point-of-care ultrasound during the consultation, so the wrist can often be assessed in the same visit.

How is De Quervain's treated, and is an injection always needed?

Many people improve with simple measures first, such as resting the thumb, modifying activities that aggravate it, a thumb and wrist splint, and pain relief. An injection is not always needed. Where symptoms persist, an ultrasound-guided injection into the tendon sheath is frequently very effective, and the ultrasound allows it to be placed precisely. The right plan is agreed with you, starting with the least invasive option that suits your situation.

I developed this after having my baby. Will it settle?

De Quervain's is common in new parents, as repeatedly lifting and supporting a baby loads these thumb tendons. The good news is that it usually responds well to treatment, particularly when addressed early. Adjusting how you lift and hold your baby, using both hands where you can, and a supportive splint often help. If the pain is not settling, a specialist review can confirm the cause and offer effective treatment.

How is it different from thumb arthritis or carpal tunnel syndrome?

All three can cause hand or wrist pain, but the pattern differs. De Quervain's causes pain and tenderness on the thumb side of the wrist, worse with gripping or turning the wrist. Arthritis at the base of the thumb tends to cause pain deeper at the thumb joint itself. Carpal tunnel syndrome typically causes tingling or numbness in the fingers rather than localised wrist pain. An assessment, with ultrasound where helpful, can clarify which it is.

When should I see a specialist about thumb-side wrist pain?

It is sensible to seek review when the pain is not settling with simple measures, when it is interfering with daily tasks or your work, or when the diagnosis is unclear. De Quervain's usually responds well to treatment, especially before it becomes long-standing, so there is little to gain from waiting indefinitely. A specialist assessment, with ultrasound where useful, can confirm the cause and offer treatment, including a guided injection where appropriate.