De Quervain’s Tenosynovitis
Pain on the thumb side of the wrist when you grip, pinch, lift or twist. The thumb tendons are squeezed in their tunnel. Common in new parents. Rest, a splint and, if needed, an injection usually sort it.
Typical signs: pain and sometimes swelling at the base of the thumb and side of the wrist, worse lifting a baby, opening jars, wringing or texting. There may be creaking or catching as the thumb moves.
Why it happens: the two tendons that move the thumb get irritated where they run through a tight tunnel at the wrist. It’s about 3 times more common in women and often follows pregnancy and the early months of lifting and feeding a baby. Repetitive gripping with the wrist bent is another trigger. Often there’s no clear reason.
Diagnosis: from the story and simple thumb and wrist movement tests, such as tucking the thumb into a fist and tilting the wrist down. Scans or X-rays are rarely needed.
The thumb-side wrist pain ladder
Most people improve with load changes and a splint. A steroid injection is the best-tested next step.
- Step 1 · Self-careChange how you use the handLift with palms up and wrists straight, scoop the baby with your forearms, take breaks from gripping, texting and wringing.
- Works
- No trials, but it removes the trigger and many mild cases settle
- Cost
- Free
- How long
- Weeks
- Watch for
- Total immobilisation for months: stiff thumb, no thanks.
Your thumb has been doing overtime. Give it some annual leave.
- Step 2 · PharmacyThumb splintA wrist-and-thumb (“thumb spica”) splint, especially for sleep and aggravating tasks.
- Works
- Weak evidence on its own, but cheap and low risk
- Cost
- About $25–60, or fitted by a hand therapist
- How long
- 3–6 weeks
- Watch for
- Too tight: numbness or tingling. Loosen it.
Ugly, unfashionable, effective-ish.
- Step 3 · PharmacySimple pain reliefParacetamol, anti-inflammatory gel or a short course of tablets.
- Works
- Little direct evidence; may take the edge off
- Cost
- About $5–20
- How long
- Short term
- Watch for
- Breastfeeding: check with your pharmacist which medicines are suitable (ibuprofen and paracetamol usually are).
Comfort while the splint does its job.
- Step 4 · ProcedureSteroid (cortisone) injectionAn injection into the tendon sheath by a GP, hand surgeon or under ultrasound. Sometimes a second one is needed.
- Works
- In small trials, for every 2 people injected, about 1 more got better than with a splint alone
- Cost
- About $0–250 depending on the clinic; sometimes bulk-billed
- How long
- Works over days to weeks
- Watch for
- Skin thinning or lightening at the injection site; a short pain flare. Diabetes: blood sugar can rise for a few days.
A small needle with a strong track record.
- Step 5 · Allied healthHand therapyA hand therapist (physio or OT) can make a custom splint and guide strengthening once pain settles.
- Works
- Helpful for splint fitting and return to tasks; limited trial data
- Cost
- About $90–130 a session; Medicare rebates with a GP care plan
- How long
- A few sessions
- Watch for
- Strengthening too early can flare it.
Specialist help for a very specific problem.
- Step 6 · SpecialistSurgeryA small operation to open the tendon tunnel, for symptoms that persist despite injections.
- Works
- Only very occasionally needed; usually relieves symptoms
- Cost
- Free in the public system (expect a wait); private costs vary
- How long
- A few weeks of recovery
- Watch for
- Numbness from irritation of a small skin nerve; scar tenderness.
The last rung. Most people never get there.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Scans for typical casesAn ultrasound isn’t needed to diagnose it and rarely changes treatment.
- Laser and therapeutic ultrasoundNo good evidence they help.
- Kinesiology tape alonePopular colours, little evidence. A proper splint does the job better.
- Stopping breastfeeding to fix your wristNot needed. Change your holding position and support the baby’s weight with pillows instead.
What you can do
- Support your baby’s weight with your forearms and pillows, not a pinched thumb.
- Wear the splint at night and for tasks that flare it.
- Break up long sessions of texting, gaming, typing or gripping tools.
- Once pain has settled, gentle thumb and wrist strengthening helps you get back to full use.
See your GP if
- Pain isn’t improving after 2–4 weeks of rest and a splint
- Pain stops you caring for a baby, working or sleeping
- Numbness or tingling in the thumb or fingers
- Several joints are swollen or stiff in the morning
See a doctor the same day for a hot, red, swollen wrist, especially with fever or after a cut or bite, or wrist pain after a fall (a broken scaphoid bone can be missed on first look).
Common questions
Why do new parents get de Quervain’s?
It often follows pregnancy and the first year with a baby. Hormone changes and the constant lifting and feeding may both play a part. It usually settles as lifting changes and with treatment.
Is a steroid injection safe while breastfeeding?
Yes, a single local injection is generally considered compatible with breastfeeding. Ask your doctor if you have concerns.
How long does de Quervain’s last?
Mild cases can settle in weeks with rest and a splint. An injection usually helps within days to weeks. Persistent cases may need a second injection or, rarely, surgery.
Is it the same as arthritis at the base of the thumb?
No, although they hurt in a similar area. Thumb-base arthritis affects the joint itself and is more common in older people. Your GP can tell them apart.
Helpful resources
- Gloucestershire Hospitals NHS: De Quervain’s syndrome leafletPrintable patient leaflet on causes and treatment options. Free, UK.
Evidence and more information
- Gloucestershire Hospitals NHS: De Quervain’s syndrome of the wrist
- Systematic review and meta-analysis: steroid injection for de Quervain’s tenosynovitis
maladywise.com/de-quervains/