Patient information · Orthopaedics and physiotherapy
De Quervain's tenosynovitis
thumb-side wrist pain, and why new parents get it
De Quervain's is inflammation of the sheath around the two tendons running to the thumb, at the thumb side of the wrist. It causes sharp pain gripping, lifting and twisting, and it is strikingly common in the first year after having a baby.
Arrange assessment rather than assuming De Quervain's if there is
- wrist pain after a fall or injury, particularly with swelling or deformity
- numbness or tingling in the thumb, index or middle fingers
- a hot, red, swollen wrist with fever
- pain at the base of the thumb in the joint itself, worse with pinching — this is usually thumb base arthritis
- tenderness in the anatomical snuffbox after a fall — possible scaphoid fracture
Thumb base arthritis and scaphoid injury both present with thumb-side wrist pain and are managed entirely differently. If there was a fall, imaging comes first.
Recognising it
- Pain and tenderness over the bony prominence on the thumb side of the wrist.
- Worse gripping, wringing, lifting, opening jars, or turning a key.
- Sometimes a thickened area or creaking over the tendons.
- A simple self-test: tuck the thumb into the palm, close the fingers over it, and bend the wrist towards the little finger. Sharp pain over the thumb side strongly suggests De Quervain's.
Why new parents get it
Repeatedly lifting a baby under the arms with thumbs extended and wrists deviated loads exactly these tendons, dozens of times a day, often alongside the hormonal and fluid changes of late pregnancy and breastfeeding. It is so characteristic it is sometimes called 'mother's thumb'. Changing the lifting technique — scooping from underneath with the forearms, keeping wrists neutral and thumbs tucked in — is genuinely part of the treatment, not an afterthought.
Treatment
- A thumb spica splint immobilising the wrist and the base of the thumb, leaving the tip free. Worn consistently, including at night, for four to six weeks.
- Activity modification — identify and change the movement that provokes it. Without this, everything else is temporary.
- Anti-inflammatory gel locally, and oral anti-inflammatories if suitable.
- Corticosteroid injection into the tendon sheath is highly effective here — unlike in many other tendon problems — and settles a majority of cases, sometimes with a single injection. It may be repeated once.
- Hand therapy with graded tendon gliding and strengthening once pain allows.
- Surgical release of the tendon sheath, a small day-case procedure, for cases not responding to splinting and injection.
While it settles
- Lift with two hands and forearms rather than pinching with thumbs.
- Avoid repetitive wringing, twisting and lifting with the wrist bent sideways.
- Take breaks from phone use held in one hand — thumb scrolling is a common aggravator.
- Expect improvement over weeks rather than days, and keep the splint on even on good days.
Book an appointment if thumb-side wrist pain is limiting you, has not settled with splinting, or you would like an ultrasound-guided injection. We offer splinting, ultrasound-guided injection, hand therapy and surgical referral, seven days a week.
Ultrasound-guided injection and hand therapy
Seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.