De Quervain's syndrome

Understanding De Quervain's syndrome

De Quervain's syndrome describes a painful restriction of 2 of the tendons that attach muscles to your thumb. These tendons can usually slide smoothly through ligament sheaths which hold them in place.

When you have De Quervain's syndrome there is a thickening of these ligaments causing resistance.

This usually occurs as an overuse injury where there is repetitive use of the thumb.

Treatment options for De Quervain's syndrome

The main aim of treatment is to allow the tendons to settle down again and stop being painful. The most effective way to achieve this is by following the right activity modification advice. After a period of rest the tendons normally start moving smoothly again.

Activity modification

Usually there will be one or two activities that you know will cause more pain in your thumb. As much as possible, try to rest from these.

There are more specific movements of your thumb that you should try to avoid.

Avoid holding things in a way in which your thumb is pointing downwards. When your thumb is pointing down the effected tendons are being stretched which puts them under more strain.

Carrying with your thumb pointing upwards removes the stretch in these tendons and allows them to work in a position that they are particularly strong in.
Try to avoid moving your thumb across your hand as this stretches the effected tendons and puts them under more strain.

Additionally try to avoid repetitive thumb or wrist movements and holding things using your thumb for long periods of time.

If you are in doubt remember to avoid painful movements with your hand as much as possible.

Thumb splint

A thumb splint will assist in preventing unhelpful movements as described above. This can usually be provided by your physiotherapist.
If this is not possible or you require a replacement they can be found by
searching for a "SPICA splint" online.

Anti-inflammatory medications

Anti-inflammatory medications can help the tendons settle again. For some people taking anti-inflammatory medications can be unsafe,
usually as they can interfere with other medications. If you have any doubts whether you should take them please contact your GP.

Exercises

Read below for advice and exercises to manage thumb pain.This guidance has been produced by the Dynamic Health physiotherapy service. It offers simple measures to help you manage your wrist problem safely. Often the right advice and exercises are all you need to improve the problem.

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise every other day

Allowing enough rest is important to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 10 repetitions of each exercise.

Rest

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it

Increase the number of repetitions (aim for 10). Or hold the positions for longer or move to a more challenging exercise.

How much pain is too much pain?

Read below for advice and exercises to manage thumb pain.

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Exercises for when your pain has settled

Exercises are not able to cure the problem in your thumb, however it is a good idea to complete them after your pain has settled in order to strengthen the involved muscles again and prevent the problem re-occurring.

Try to repeat either the first 2 (no band), or last 2 (with the finger strengthener band) once a day for a period of 2 months. Stop the exercises if they become painful.

When you move onto the exercises using a resistance band, you can use standard elastic bands. However, specific finger strengthener bands are preferable.

We are not able to provide these ourselves however they are inexpensive and can be found online by searching "finger strengthening band".

Resisted thumb abduction

Resisted thumb extension

Start with your hand on a table, palm facing downwards, thumb in a neutral position.

Slide your thumb out to the side along the table, whilst resisting with your other hand so that you complete the movement slowly.

Return your hand to a neural position and repeat.

Repeat approximately 10 repetitions or until fatigue.

When these first 2 exercises are feeling easy to complete move on to using a band as shown below.

Thumb abduction with finger strengthener

Place all your fingers (except the little one which will be too weak to be involved) into the loops of the band, and place your thumb in the larger loop for the thumb.

Start with your hand on a table with palm facing up and thumb relaxed.

Try to pull your thumb up towards your body as much as you can whilst holding the band in place with your fingers.

Hold the tension for 5 seconds and then return to the resting position.

Repeat 10 repetitions, rest for a few minutes and then return and complete another 10 repetitions.

Thumb extension with finger strengthener

Radial/ulnar deviation

Need more help?

Consider self referring using the link below

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Click the link below for self-referal

Click here to refer yourself to physiotherapy