De Quervain's Tenosynovitis: The Holiday Wrist | Form & Function MD
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De Quervain’s Tenosynovitis: The Holiday Wrist

Form & Function MD · Dr. Ben, MD

Dr. Ben, MD · Orthopaedic Hand & Upper Extremity Surgeon

A new grandparent comes in after the holidays with pain on the thumb side of the wrist. It started a week or two after the grandchildren arrived and gets worse every time they lift the baby. This is one of the most recognizable patterns in hand surgery: De Quervain's tenosynovitis.

What's happening

Two tendons that move the thumb, the abductor pollicis longus and the extensor pollicis brevis, run together through a tight tunnel on the thumb side of the wrist called the first dorsal compartment. When those tendons and the tunnel become irritated and thickened, the tendons no longer glide smoothly, and moving the thumb or wrist becomes painful.

Who gets it
  • New parents, particularly in the months after delivery
  • Grandparents and caregivers lifting infants and toddlers
  • People who do repetitive pinching, gripping, or wrist motion: gardening, racquet sports, fly casting, extended phone or controller use
  • More common in women and in middle age
Lift the baby with your palms up, not with your thumbs out.

Why lifting a baby triggers it

The classic lift, hands under the baby's arms with the thumbs spread wide in an L shape, loads exactly these two tendons while the wrist moves. Do it dozens of times a day and the tunnel becomes inflamed. Changing how you lift is one of the simplest and most effective parts of treatment.

The test you can do at home

Tuck your thumb into your palm, wrap your fingers over it, and gently tilt your wrist toward your pinky. Sharp pain on the thumb side of the wrist suggests De Quervain's. Strictly speaking this is the Eichhoff test, though it's widely called Finkelstein's test. It isn't perfect, since other problems can also hurt with this maneuver, but it's a strong clue.

Other causes of thumb-side wrist pain
  • Arthritis at the base of the thumb (CMC joint)
  • A scaphoid fracture, especially after a fall
  • Intersection syndrome: irritation a little higher up the forearm where tendons cross
  • Irritation of the small nerve that runs over this area

Treatment

Most cases improve without surgery.

What works
  • A thumb spica splint that holds the thumb still, worn during aggravating activities and at night
  • Changing the lift: palms up, scooping under the baby's bottom and back, thumbs tucked alongside the hand
  • Short-term anti-inflammatory medication or ice for symptom relief, if appropriate for you
  • A corticosteroid injection into the tendon sheath, which relieves symptoms for most patients and is often the most effective single treatment
  • Surgical release of the tunnel for the minority who don't improve: a short outpatient procedure under local anesthesia

Some people have a small wall inside the tunnel that divides the two tendons into separate channels. When that's present, an injection may not reach both tendons, which is one reason injections occasionally fail. During surgery, both channels are released, and the small sensory nerve that runs over the area is carefully protected.

A few weeks of the right splint and the right lift fix most of these. The key is not to keep lifting through the pain.
When to see a hand surgeon
Thumb-side wrist pain that persists beyond a few weeks despite a splint and changing how you lift, pain that's severe enough to limit daily care of a baby, or symptoms after a fall should be evaluated. Postpartum patients who are breastfeeding can discuss injection safety with their physician.

This article is for education, not a diagnosis. If something here sounds like you, see a physician who can examine you.

  1. Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757–764.
  2. Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database Syst Rev. 2009;(3):CD005616.