De Quervain Tenosynovitis: What Helps Thumb-Side Wrist Pain?

New mothers are often surprised by where the aches of early parenthood turn up. For a good number it is not the back. It is the wrist, on the thumb side, every time they lift the baby out of the cot.

The usual cause is de Quervain tenosynovitis, first described by the Swiss surgeon Fritz de Quervain in 1895. A study of more than 1.6 million pregnant women in South Korea found that about 2 in every 100 developed it during pregnancy or in the months after the birth. Parents are not the only ones affected. Anyone who does a lot of repetitive gripping and lifting can develop it, and in the 30 trials pooled in a 2023 review the average patient was 46 years old and four in five were women.

What is de Quervain tenosynovitis?

Two tendons run from the forearm to the thumb. They pull the thumb out and away from the hand. On the way they pass through a short tunnel on the thumb side of the wrist, inside a lining called the tendon sheath.

In de Quervain tenosynovitis that tunnel becomes thickened and tight. The tendons no longer glide freely, so moving the thumb or bending the wrist towards the little finger hurts. Despite the “-itis” in the name, the tissue under the microscope is mostly thickened, with little sign of inflammation.

People usually notice pain and tenderness just below the base of the thumb, sometimes with swelling. Lifting, opening a jar or wringing out a cloth sets it off. Some feel a catch or a creak as the tendons move.

Is it arthritis?

Many people assume pain at the base of the thumb is arthritis. Sometimes it is. Osteoarthritis of the joint at the base of the thumb is common from middle age, and it sits only a couple of centimetres away. Arthritis pain is felt deep in the joint where the thumb meets the wrist, often with grinding, and pinching makes it worse. De Quervain pain sits a little higher, over the tendons on the side of the wrist, and it is worst when the thumb is stretched across the palm.

A GP can usually tell the two apart by examination. In one simple test the thumb is tucked into the palm, the fingers close over it and the wrist tips towards the little finger. In de Quervain tenosynovitis that is usually sharply painful. Most people do not need a scan. An X-ray helps when arthritis or a fracture is a real possibility, and ultrasound can show the thickened sheath when the diagnosis is in doubt.

Pain after a fall, a wrist that looks deformed, numbness in the hand, or a hot, red, swollen wrist with a fever all point to something else, and need prompt medical assessment.

How is it treated?

Mild cases often settle once the task that provokes them changes. For new parents, the way the baby is lifted matters. Scooping the baby up with the palms facing up and the wrists straight takes most of the strain off the tendons. Gripping under the arms with the thumbs spread wide does the opposite.

A splint that holds the thumb and wrist still, known as a thumb spica splint, is the usual next step. It is cheap and carries little risk. A hand therapist (a physiotherapist or occupational therapist with extra training in hand problems) can fit one, and can be seen privately without a referral. Splints are most useful worn for the painful tasks and at night. Worn all day for weeks, a poorly fitting splint can leave the thumb stiff.

When pain persists, a cortisone injection into the tendon sheath is the treatment with the most evidence behind it. A 2024 review by an Australian team pooled 16 trials involving 1,206 people. Injection succeeded more often than a splint alone, and injection combined with a splint did better than either on its own. A larger 2023 review of 30 trials reached much the same view. Adding three to four weeks in a splint after the injection improved hand function a little, though by less than most people would notice. Injections placed with ultrasound guidance ranked best for pain.

Cortisone has side effects. The skin over the injection site can thin or lose some of its colour, which shows more on darker skin. Pain can flare for a day or two. People with diabetes may see their blood sugar rise for a few days, and infection is rare. An injection does not strengthen the tendon, and the pain can come back.

When is surgery needed?

Surgery is kept for people whose pain stays troublesome despite these treatments. Under local anaesthetic, a hand surgeon opens the roof of the tight tunnel so the tendons have room to move. Most people do well. The main risks are a tender scar and irritation of a small skin nerve that runs right over the area, which can leave tingling on the back of the thumb. Recovery takes several weeks.

Will it get better?

For the new mother lifting her baby a hundred times a day, the outlook is good. Many cases settle with time and a splint, and an injection helps most of those that don’t. The first step is making sure the pain really is coming from the tendons.