De Quervain’s Tenosynovitis is a painful inflammation of tendon sheath on the side of the wrist at the base of the thumb.

Thetendon sheath includes the muscles, extensor pollicis brevis (EPB) and the abductor pollicis longus(APL). These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb. The pain, which is the main complaint, gets worse with the abduction of the thumb, grasping action of the hand, and an ulnar deviation of the wrist. Thickening and swelling can also be present.

Causes of De Quervain’s Tenosynovitis

  • It is associated with repetitive wrist motion, specifically motion requiring thumb abduction and simultaneous extension and radial wrist deviation.
  • The most common cause is chronic overuse.
  • Activities such as golfing, playing the piano, fly fishing, carpentry, office workers and musicians can lead to chronic overuse injuries.
  • Repetitive gripping, grasping, clenching, pinching, or wringing of objects can cause inflammation of the tendon sheaths.

Clinical Presentation

  • The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb.
  • Swelling in the anatomical snuff box, tenderness at the radial styloid process.
  • Palpable thickening of the extensor sheaths.
  • Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms.

Treatment Options

  • Bracing and immobilising the Thumb. Your Physiotherapist can help arrange appropriate brace for you.
  • Rest and activity modifications
  • Shockwave and dry needling to reduce pain and inflammations
  • Strengthening exercises of wrist and thumb joint, once pain settles.
  • Thumb taping
  • In cases where the pain and symptoms persist, your GP may prescribe you scripts for anti-inflammatory and may suggest Cortico-steroid injections.