De Quervain’s tenosynovitis is a painful, inflammatory condition that affects the tendons and the sheath (the covering or casing around the tendon) in your wrist that run to your thumb. It is caused by overuse and repetitive strain of the thumb triggering an inflammatory process to start in the sheath. Treatment of a De Quervain’s tenosynovitis is easy – only if it’s treated correctly.

Tendons are the rope like structures that connect the muscles in your forearm, to the bone in your thumb. When you contract the muscle it pulls on the tendon and moves your thumb. Normally the tendons glide freely through a narrow passage, over the wrist and into the thumb. With De Quervain’s, the sheath surrounding the tendon swells up, restricting the movement of the tendon. As the swelling becomes more, the friction between the tendon and the sheath becomes more. This is the endless cycle you’re trapped in. The more friction, the more the swelling.

When you rest the wrist and the thumb it eases the pain for a short while but as soon as you grip, pinch, stretch or wring any object the pain returns as the gliding of the tendon is no longer smooth and easy. Back into the cycle of swelling and increased friction. The pain progressively get worse as the swelling around the tendon increases.

The structures mainly involved with De Quervain’s is the radial styloid, the extensor tendons of the thumb and the sheath covering these tendons. The sheath and tendon acts like a rope being pulled through a pipe. The sheath is the pipe, and the tendon the rope. As the rope gets pulled through the pipe, if there is thickening in the rope, it scratches along the inside of the pipe. This friction limits movement and causes pain.

The radial styloid is the tip of the radius bone in your forearm. The radial styloid can be felt on the thumb side of the wrist just below where the thumb meets the wrist. It is a round bony protrusion. De Quervain’s tenosynovitis is centered around this specific bony knob.

There are two extensor tendons of the thumb, the Extensor Pollisis Brevis (EPB) and the Abductor Pollicis Longus (APL) that runs over along this channel. The Extensor Pollisis Brevis tendon straightens your thumb straight and the Abductor Pollicis Longus pulls the thumb away from the index finger. Both of these tendons cross the wrist next to the radial styloid through a narrow tunnel. This is the tendons involved in De Quervain’s tenosynovitis, and treatment is focused on them.

Synovitis refers to the synovium – this is the medical term for the sheath. De Quervain was the surgeon that originally classified the condition. The overuse of a repetitive motion, doing the same movement over and over again, eventually triggers the initial inflammatory cycle.

These scenarios explains how easy it is to develop a De Quervain’s tenosynovitis.

Console gamers develop De Quervain’s tenosynovitis after hours and hours of endless gaming in a tournament. The repetitive motion of the thumbs on the controller keys, even without heavy lifting the repetition of the motion itself is enough to start the process. In e-sports its commonly known as ‘gamers thumb‘.

New mothers tends to get De Quervain’s tenosynovitis from constantly picking up their child. As the child grows, the load on the tendons gradually increases, putting more strain on a already compromised tendon. Nursing of a child while the thumb is pulled away, like when bottle feeding even adds to the problem. This is dubbed ‘mothers thumb‘.

Texting thumb. It’s a very common sign among phone addicts texting all day long. Holding your phone in one hand places extra strain on these tendons to sustain the position of your wrist while your thumb is typing away. Scrolling adds fuel to the fire, and creates the ideal conditions for De Quervain’s tenosynovitis to appear. The pain slowly creeps up, to the point where you consider switching over to the other hand. In the worst cases you end up texting like your granny just to avoid the pain over the base of your thumb. Treatment focuses on limiting your specific aggravating factors.

De Quervain’s tenosynovitis is painful to place pressure on the thumb and move the wrist like pinching, gripping and twisting motions can also bring on your pain. You find it difficulty holding objects where your thumb needs to go around it, moving the wrist side to side when pinching with the thumb and lifting the thumb up into the air to make a sharp sign.

The severity of De Quervain’s tenosynovitis is clinically grouped as mild, moderate or severe. It is dependent on how long your pain has been present, how intense your pain is and how much function and active range of motion you have lost. Clinical tests are used to test the tendon and rating the pain which classifies it under the groups of mild, moderate and severe.

The characteristics of a mild case includes, slight intermittent pain only when holding more than 5 kg. The pain tends to dissipate immediately when your hand is relaxed. Moderate signs are more frequent pain that lasts longer, especially when texting. However the most severe cases of patient with De Quervain’s tenosynovitis complains of constant pain and dropping items quickly after you pick it up. The regression from one class to a more severe case happens quite fast. Patients in the severe category tend to have longer treatment, slower recovery, and may even end up in surgery.

We are experienced in testing the different types of problems that can cause your thumb and wrist pain. Our medical professionals use a variety of clinical tests and evaluations to determine the extent of the damage. We mainly test the two tendons as well as the muscles and ligaments of the thumb and wrist. We’ll screen other structures in your hand to make sure there’s no complications or compensations. If your tests prove that we suspect De Quervain’s tenosynovitis, we even start with your treatment protocol in the first consultation.

Usually further investigations like Sonar, X-rays and MRIs are not needed, but we will refer you if need be.

You may have stopped loading exercises like going to the gym and doing bicep curls, hoping that this will reduce the pain, but you are still continuously using the thumb on your phone for texting or picking up your baby under the arms with your thumb stretched out. These repetitive movements, although not always under a high load, continues to aggravate the inflammatory cycle and your tendinitis, gets worse. It is important to rest your tendons in the right way to truly insure that healing takes place.

If your pain is longstanding you could develop secondary complications and other tendinitis. Your body instinctively knows that it should not be using the thumb in certain ways as this causes pain, you then over compensate using other muscles and tendons to try to offload your thumb. When you switch over to your other hand, it also risks developing a De Quervain’s tenosynovitis which leaves you with two painful hands. De Quervain’s tenosynovitis may spread to your elbow, radiating into the extensors of your forearm.

Generic braces and wrist straps – It doesn’t isolate the thumb and allows for too much thumb and wrist motion to effectively gaurd and protect your thumb’s extensor tendons. The design is made to fit for various conditoins, and we tend to see that these wrist braces place even more pressure on the thumb’s radial styloid and compress the extensor tendons even more.

Injections – Effective for short term relief and masks the true pain. Leaving you to gradually regress the state of the tendon and a few weeks later, you’re back to square one with the same pain as before.

Medication – Effects the inflammatory process, but it is crucial to gradually build up the tendon’s capacity to withstand repetitive loaded forces. Medication alone will not improve the capacity.

Waiting too long will cost you more time and money to fix your problem. The longer you wait before you start the healing process, the bigger the chance that you may require more aggressive treatment techniques. First we must establish the state of the tendon and classify the severity, and in most cases the pain is a poor indicator of the condition of the tendon. The problem is far worse than your pain threshold.

We use the latest, proven research based protocols to test, diagnose and treat. Our treatment is tailored in stages and you’ll progress when you’ve achieve certain goals. Our treatment of De Quervain’s tenosynovitis also includes machines and the newest technology. The De Quervain’s tenosynovitis treatment program runs for 8 weeks, initially we’ll see you twice a week for the first month, thereafter follow up appointments are once every two weeks and clearance examination is scheduled in the last month.

Splinting – A custom splint designed and tailored for your thumb and wrist, to allow optimal healing.

Strapping – Making use of a softer strap (brace) that is custom made and fitted to your hand specifically.

Taping – Using tape to offload the tendon and allow for healing whilst still being able to move and use the hand.

Passive Exercises – To keep the function of all non-affected joints.

Active exercises – To regain and strengthen the tendon and muscles. Build capacity using a graded progressive loading protocol.

Tendon gliding techniques – This is the core component of the treatment for De Quervain’s tenosynovitis, to ensure uninterrupted, smooth gliding of the extensor tendons, without restrictions. It’s vital to reduce the friction causing thickening of the tendon and it’s sheath.

• Achieve active and passive range of motion
• Regain full grip strength
• Delicate fine motor coordination and control
• Pain free functional use of your thumb and hand
• At the end of this stage you should be able carry a plate of food pinching your thumb to the plate.

The recovery time for De Quervain’s tenosynovitis may be as short as 4-8 weeks or up to 12 weeks, depending on multiple factors. The healing time depends on how long the inflammation cycle has been present and how well the tendon is able to withstand the increase in load capacity combined with repetition volume.

• Radial styloid tendinitis
• Mommy thumb
• Texting thumb
• Gamer’s thumb

• Scaphoid Fracture – Pain is more intense with direct pressure over the anatomical snuff box, and initiated by trauma.
• Radial Styloid Fracture – Compression and gripping is more painful.
• Tendinitis of any other tendon to the wrist
• Thumb Osteoarthritis – Degenerative changes of the base of the thumb
• Lateral epicondilytis (Tennis Elbow) – Pain radiate downwards into forearm starting at the elbow towards the thumb.
• Trigger finger – Snapping of the tendon and the pain is more on the palm’s side of your thumb.