DeQuervain’s Tenosynovitis
Date issued: December 2023
Review date: December 2025
Ref: C-325/Physiotherapy/AM/DeQuervain’s Tenosynovitis v2
PDF: DeQuervain's Tenosynovitis 2023 v2.pdf[pdf] 572KB
What is DeQuervain’s?
DeQuervain’s tenosynovitis is caused by irritation to the sheath surrounding the two tendons that help move the thumb. The tendons run between the thumb and wrist and may be swollen and thickened over the area. It can progress to become very painful to move the thumb.
What are the causes?
In many cases the causes are unknown. However it is more common in women and particularly following pregnancy. Other possible causes include overuse of the tendon and repetitive movements. Symptoms can also present following a simple strain or through trauma.
What are the symptoms?
The main symptoms are pain and swelling near the base of the thumb. Functions you may struggle with include pouring water from a kettle, opening jars and pain can include pinching, grasping or wringing and any other movements involving the thumb and wrist.
Diagnosis:
Diagnosis is normally done through the information you provide to the practitioner from a clinical examination. This will normally involve a series of thumb based movements and tests (see picture below). If the pain at the base of your thumb is made worse, the test is considered positive.
Treatment :
Rest: It is important to avoid aggravating activities to allow the pain and irritation to settle.
Splinting: A long based splint that immobilises your wrist and thumb has been show to be the most effective in managing your symptoms this can range for a period of 3-8 weeks.
NSAIDs: Regular non-steroidal anti-inflammatories can help manage the swelling and reduce pain. Discuss this option and further pain relief with your local pharmacist or GP.
Physiotherapy: A series of progressive pain free exercises may be given to you by your physiotherapy to help improve your hand function. Alongside advice on managing your symptoms.
Steroid injection: If physiotherapy is unsuccessful, it may be appropriate to have a steroid injection into the base of the thumb to help reduce the pain and swelling
Surgery: If all other interventions have failed to treat the condition surgery may be considered. This is done as a day case surgery where a small cut is made to the tendon sheath allowing the tendons to move freely.
Exercise program: Phase 1
1) Thenar stretch
You may be advised to wear a splint continuously on your wrist for up to 4 weeks to help settle your symptoms initially.
Using the other hand to assist, gently stretch the base of your thumb away from you.
Repeat this 8-10 times with a 15-20 sec hold
2) Finklestein’s stretch
Rest your forearm on a table with your hand off the end.
Bring your thumb over to the base of the little finger. Wrap your fingers around your thumb and slowly lower your hand down off the table.
Repeat 8-10 times with a 15 –20 second hold
3) Wrist flexion and extension
With your forearm supported gently move your hand up and down to ensure full movement at the wrist.
Repeat 8-10 times for each movement.
Thumb abduction
Use the other hand to assist the thumb out to the side then let it return on its own to the starting position.
Repeat 10 x 4 x daily
Thumb extension
Use the other hand to assist the thumb upwards and then let it return on it’s own to the starting position.
Repeat 10 x 4 x daily
Exercise program: Phase 2
Hammer curl
Use your other hand to assist the affected side into the starting position. Make sure your forearm is supported on a table.Let go of your affected wrist and gently lower the wrist down.Repeat 10 times 4 times daily
Exercise program: Phase 2
Thumb abduction
Move your thumb out to the side and back to the starting position as shown in the photo.
Repeat 10 x 4 x daily
Thumb extension
Move you thumb upwards and then back to the starting position as shown in the photo.
Repeat 10 x 4 x daily
Exercise program: Phase 3
Hammer curl
Rest your forearm on a table. Make a fist then lower then wrist down off the table. Then return to the starting position.
Repeat 10-15 x 4 x daily
Thumb with elastic band: Abduction
Wrap an elastic band around your fingers and thumb.
Pull your thumb out away from your fingers against the resistance of the band.
Repeat 10-15 x 4 x daily.
Thumb with elastic band: Extension
Hold an elastic band around your thumb. Gently lift your thumb up against the resistance of the band. Then return to the starting position.
Repeat 10-15 x 4 x daily.
Exercise Program: Phase 3
Grip
Hold a soft ball or ball of socks in your hand. Gently squeeze your hand to try to make a fist.
Repeat 10-15 x 4 x daily.
Further advice and useful links:
- If after 4 weeks you are struggling to regain function and range of movement you can self-refer to physiotherapy using the following link or via your GP:
- Further advice on health related issues can be found on the NHS Choices website:
http://www.nhs.uk/pages/home.aspx
