An Occupational Therapy Guide to de Quervain's Tenosynovitis
If you've ever experienced wrist pain, you've probably noticed how much it affects your daily life. From opening jars, turning a key, using a garden shovel, to lifting a young child, wrist pain — and more specifically de Quervain's tenosynovitis — can make daily tasks feel impossible.
Wrist and hand pain are quite common, prevalent in 10% of the general population.1 Often, de Quervain's tenosynovitis is the culprit. Fortunately, you can get relief pretty quickly through proper conservative management.
This guide will give you a quick breakdown of de Quervain's tenosynovitis (sometimes called Mommy's wrist), its treatment, and how seeing a Certified Hand Therapist and occupational or physical therapist can help.
- Understanding de Quervain's Tenosynovitis
- Symptoms of de Quervain's Tenosynovitis
- What are the Most Common Causes of de Quervain's Tenosynovitis?
- Diagnosing de Quervain's Tenosynovitis
- What to Expect from Hand Therapy
- Preventing de Quervain's Tenosynovitis
- Is It Time to Seek Treatment?
De Quervain's tenosynovitis affects two tendons on the thumb side of the wrist: APL (abductor pollicis longus) and EPB (extensor pollicis brevis). These two tendons cross the wrist and help move your thumb out away from your fingers (radial abduction).
Like a puppet with strings, our body is full of anchor points to make the pull of tendons and muscles more efficient. However, these areas of efficiency can quickly become areas of compression and pain from overuse, hormones (such as in new mothers or parents), or trauma.
Additionally, the fluid that usually helps these tendons glide under the pulley system can become thick and sticky, increasing friction under the pulley which can cause irritation and swelling to the tendons. In the case of de Quervain's tenosynovitis, the tendons run under the thumb side of your wrist (called the first dorsal compartment), and this tight spot becomes painful with combined wrist and thumb action.
What are the symptoms of de Quervain's tenosynovitis? Let's review:
- Dull ache on thumb side of wrist
- Sharp, shooting pain on thumb side of wrist when grasping thumb and bending wrist toward pinky side (Finkelstein's maneuver)
- Decreased ability to perform daily tasks like opening jars, lifting young children, writing, typing, washing dishes
- Tenderness to touch over the thumb side of the wrist
- Decreased motion due to pain
- Swelling over the thumb side of the wrist
While many different types of folks can experience de Quervain's Tenosynovitis, below are the most common causes.2
- Repetitive stress on the tendons (like hammering or picking up a young child)
- Ages 40-60 years old
- Female sex
- More rarely, trauma, like a fall
- Genetic predisposition due to bone structure (prominent radial styloid)
If you are experiencing wrist pain, proper diagnosis from a CityPT specialist like a CHT — who is an occupational or physical therapist with additional specialty training — will help you get better quicker and return to those daily activities that are most meaningful to you, pain-free.
Alternatively, you could see your primary care doctor or orthopedic surgeon. But, to get the best conservative care with less need for pain medications, injections, or surgery, it's best to see a CHT for long-term relief and sustainable results.
The sooner your wrist pain is properly diagnosed, the better the results will be. Therefore, it's best to seek treatment as soon as possible.
Medical evaluations can be scary and overwhelming. We strive to make it less so by providing you with an idea of what you can expect at your evaluation.
Your therapist might ask you questions to get to know you to aid in shaping your recovery. The questions may be along the lines of:
- When did your wrist pain start?
- How did it start?
- What activities or positions make it better or worse?
- Do you have any medical conditions we should know about?
- What are three things you cannot do right now that you wish you could because of your wrist pain?
- What major life changes have you experienced in the last year?
Your CityPT therapist will also perform a thorough telemedicine or in-person evaluation, which may include:
- Differential diagnostic testing to evaluate tissue, joint, or muscle integrity
- Measuring range of motion and strength
- Testing functional abilities
- Noting sensory changes, like numbness or tingling
- Palpating areas of tenderness
- Observing swelling (edema)
What If Conservative Treatment Doesn't Work?
Sometimes, despite best efforts, conservative management fails. This can be due to the duration of symptoms or in the specific case of de Quervain's tenosynovitis, it can be due to genetic predisposition. If you have tried conservative management and continue to experience pain and dysfunction, your therapist may refer you to your physician who may offer:
- Injections: Cortisone injections, while not always effective, can offer temporary relief from the pain to allow your body to heal itself.
- Surgery: When all else has failed, your physician may offer surgical release of the first dorsal compartment to give the irritated tendons more room to glide with less friction. You will likely be referred to therapy post-operatively as well to ease you back into meaningful daily activities. Your hand therapist will help by addressing range of motion, functional adaptations, tendon gliding, swelling and scar management, and increased strength.3
Whether you are a new mother looking to prevent "Mommy's Wrist" or someone who might be experiencing intermittent pain on the thumb side of their wrist, here are some ideas to consider for prevention.
Stay active: Motion is lotion. Moving is grooving. Gentle stretching and strengthening as part of an active lifestyle can reduce the likelihood of developing de Quervain's tenosynovitis.
Scoop palm up instead of gripping and deviating: For example, if you are a new parent and lift your little one, try scooping palm up instead of gripping palm sideways. That way, you are using larger muscle groups and reducing the stress on your wrists. This method can be applied to any type of lifting — whether it's a new human or a plate or bowl.
Make healthy lifestyle choices: While it can be fleeting as a new parent, try to get enough sleep, stay hydrated, and eat nutrient dense foods. Practice healthy stress management. Your whole body will thank you!
Try splinting: Nighttime splinting in a thumb spica splint (one that includes the wrist AND the thumb) can help position your wrist and thumb ergonomically while you sleep giving your tendons a much needed break.
Talk to a Certified Hand Therapist: If you have concerns or want professional advice on splinting, treatments at home, and functional adaptations, make an appointment!
If your symptoms are getting in the way of your daily independence or if you have already tried self-treatment but your symptoms persist, it may be time to seek professional help. Or, if you are not sure where to start, it may be time to see a hand expert. A Certified Hand Therapist can create a custom plan to ease your pain and help you return to your most meaningful daily activities.
Schedule an appointment with one of our hand experts today. They'll work with you to find the root of your pain and improve your independence with daily activities, getting you on the path to recovery.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Ferguson R, Riley ND, Wijendra A, Thurley N, Carr AJ, BJF D. Wrist pain: A systematic review of prevalence and risk factors – what is the role of occupation and activity? BMC Musculoskeletal Disorders. 2019;20(1). doi:10.1186/s12891-019-2902-8 ↩
Allbrook, Victoria, The Side of My Wrist Hurts: de Quervain's Tenosynovitis. The Australian Journal of General Practitioners. 2019 November; 48(11): 753-756. doi: 10.31128/AJGP-07-19-5018 ↩
Erikson, John M., Help for Thumb and Wrist Tendinitis. Hand Care The Upper Extremity Expert 2022, July. Available at: https://www.assh.org/handcare/blog/help-for-thumb-and-wrist-tendonitis. Accessed July 22, 2022. ↩