Meet Emily
Emily is a 35-year-old new mother who began to experience intense pain and swelling along the thumb side of her wrist. She had been struggling with everyday tasks like lifting her baby, fastening car seat straps, and even holding her phone. She has recently been diagnosed with De Quervain’s tenosynovitis, a condition common among postpartum mothers due to repetitive wrist and thumb movements.
What is Dequervain's Tenosynovitis (thumb tendonitis)?
Causes & treatment
De Quervain’s tenosynovitis is a painful condition that affects the tendons on the thumb side of your wrist. If you've noticed pain when gripping, twisting, or lifting objects, you may be dealing with this condition. As hand therapists, we often help patients relieve the symptoms of De Quervain’s, restore function, and prevent further injury.
Your wrist contains a number of tendons that help control the movement of your fingers and thumb. De Quervain’s tenosynovitis specifically affects two tendons: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).
These tendons are responsible for moving your thumb away from your hand and extending it.These tendons pass through a small tunnel or sheath at the base of the thumb.
When the tendons or the sheath become irritated and inflamed, it leads to pain, swelling, and difficulty moving the thumb and wrist. This is the hallmark of De Quervain’s tenosynovitis. The pain is often felt along the thumb side of the wrist and can sometimes radiate up the forearm.
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Several factors can contribute to the development of De Quervain’s tenosynovitis:
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Repetitive Hand and Thumb Movements: Activities that involve repetitive motions, such as lifting a child, using a smartphone, or typing, can cause irritation to the tendons. This is common among new parents who frequently lift their baby, feed, comfort and hold their baby.
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Direct Injury or Trauma: A direct blow to the wrist or thumb can cause inflammation and swelling of the tendons.
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Inflammatory Conditions: People with inflammatory conditions such as rheumatoid arthritis are at a higher risk of developing De Quervain’s due to the changes in soft tissue and joint health.
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Age and Gender: The condition is more common in individuals between 30 and 50 years of age, and women are at a higher risk, particularly during pregnancy and postpartum periods due to hormonal changes and increased use of the hands
How can hand therapy help De Quervain’s tenosynovitis?
Hand therapy plays a crucial role in managing De Quervain’s tenosynovitis. The primary goals of therapy are to reduce inflammation, relieve pain, and restore movement in the thumb and wrist.
Splinting
Splinting: A splint is often used to immobilize the thumb and wrist, allowing the inflamed tendons to rest and heal.
The splint, usually worn for several weeks, will keep the thumb in a neutral position while still allowing the fingers to move.
Wearing the splint especially during activities that aggravate the condition can significantly reduce pain.
Activity modification
We’ll work with you to identify movements and activities that are contributing to your symptoms.
Modifying these activities—such as reducing thumb-heavy tasks or adjusting your ergonomics—can prevent the
condition from worsening. For example, we may recommend changing the way you lift objects, encouraging more frequent rest breaks, or changing biomechanics to alter task
Stretching exercises
Gentle stretching can help relieve tightness in the tendons and improve range of motion without aggravating the inflammation.
Thumb stretches: Gentle movements that stretch the tendons in the thumb and wrist can help reduce stiffness.
Manual therapy
Massage and soft tissue mobilisation can reduce tension in the surrounding muscles and improve circulation, promoting tendon healing.
Techniques such as gentle thumb and wrist massage can relieve pain and reduce swelling.
Your therapist will use specific techniques to ensure the massage is beneficial without causing further irritation.
Ergonomics adjustments
If your symptoms are related to work or daily activities, we can help you make ergonomic adjustments to your setup.
For example, adjusting the height of your chair or changing the way you hold a pen can reduce the strain on your thumb and wrist, preventing further irritation.
Once inflammation has subsided, we’ll introduce strengthening exercises to restore function and prevent future injury.
Targeting muscles that support the wrist and thumb, helping you regain strength in a controlled manner.
Cold & heat therapy
Applying ice packs to the affected area can help reduce swelling and inflammation, while heat therapy can be useful to relax the muscles and improve blood flow to the area.
Your therapist will advise you on when and how to use these therapies effectively.
Frequently asked questions about Dequervain's Tenosynovitis
What movements should be avoided with De Quervain's tenosynovitis?
It’s important to avoid movements that strain the tendons in the thumb and wrist. These include repetitive thumb movements, heavy gripping, pinching, or twisting actions, and lifting objects with your palms down. Activities like typing or excessive smartphone use should be minimized, especially if they cause discomfort.
How do you massage De Quervain's tenosynovitis?
Massage can be helpful for managing the pain and inflammation associated with De Quervain’s, but it must be done carefully. Gentle massage around the thumb and wrist can improve circulation and reduce tension in the tendons and surrounding muscles.
It’s important to avoid deep pressure directly on the inflamed tendons, as this can worsen the condition. Your hand therapist can show you safe, effective techniques to use at home.
If you’re experiencing pain, swelling, or difficulty moving your thumb or wrist,​it’s important to seek early treatment. Hand therapy can provide effective, non-invasive solutions to help you recover from De Quervain’s tenosynovitis and return to your daily activities pain-free.