De Quervain’s Tenosynovitis Treatment in Singapore

Q: What exercises help with De Quervain's?

Important Note: Exercises should only be initiated once sharp pain has subsided, usually during the recovery phase. Starting too early may aggravate the condition. Gentle stretches, like slowly bending the wrist up and down or touching the thumb to each fingertip, can help restore movement later on. Your specialist or a hand therapist can advise on the right exercises for your stage of recovery.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

De Quervain’s tenosynovitis is a painful wrist condition that affects the tendons located on the thumb side of the wrist. It can cause discomfort during everyday activities such as gripping, lifting, typing, or caring for a child, especially when repeated thumb and wrist movements increase irritation around the affected tendons.

At Advanced Hand, Wrist & Nerve Centre, our hand specialists assess persistent thumb-side wrist pain to determine whether symptoms are caused by De Quervain’s tenosynovitis or another underlying wrist condition. Depending on the diagnosis, treatment options may include activity modification, splinting, medication, corticosteroid injections, or tendon sheath release surgery when appropriate.

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older asian lady experiencing DeQuervain’s Tenosynovitis in Singapore

What Is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis occurs when the tendons that control thumb movement become irritated as they pass through the first dorsal compartment of the wrist. When the tendon sheath becomes swollen or thickened, movement through this narrow space can become painful.

Symptoms Causes Diagnosis Treatment Prevention FAQ

Why your thumb pain won’t go away? De Quervain’s Tenosynovitis explained

lady experiencing De Quervain’s Tenosynovitis in Singapore

Symptoms of De Quervain’s Tenosynovitis

Individuals with De Quervain’s tenosynovitis often experience symptoms that are aggravated by specific thumb or wrist movements. Common symptoms include:

Pain near the base of the thumb: This pain may extend up the forearm and can worsen during activities like pinching or grasping. In advanced cases, subtle thumb or wrist movements may provoke discomfort.
Swelling on the thumb side of the wrist: Swelling may be visible near the wrist joint, sometimes accompanied by small, fluid-filled changes at the base of the thumb.
Difficulty moving the thumb and wrist: Tasks involving thumb motion or heavy gripping can become increasingly difficult and uncomfortable.
Snapping or catching sensation: A clicking or snapping feeling may occur when moving the thumb, often due to tendon restrictions caused by thickening of the tendon sheath.

When Should You See a Wrist Specialist?

Consider arranging a consultation if thumb-side wrist pain continues despite rest, affects gripping or lifting, causes local swelling, or makes daily tasks difficult. You should also seek clinical assessment if the pain follows an injury, worsens over time, or limits normal thumb and wrist movement.

A wrist specialist assessment can help confirm whether the symptoms are due to De Quervain’s tenosynovitis or another underlying wrist condition.

Causes & Risk Factors Of De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is often caused by repetitive stress or strain on the thumb tendons, with several factors contributing to its development:

Repetitive hand movements: Actions like typing, gardening, or lifting a child using the thumb for leverage can strain the tendons. Overuse may irritate the tendon sheath, leading to thickening and restricted movement.
Direct injury to the wrist or thumb: Trauma, such as a wrist fracture, can increase stress on the tendons or lead to scar tissue formation, which impairs tendon movement.
Inflammatory conditions: Disorders like rheumatoid arthritis can raise the likelihood of developing this condition by affecting broader tendon health.
Hormonal changes: Pregnancy and breastfeeding are linked to a higher risk, possibly due to hormonal fluctuations affecting tendon and ligament elasticity.

How Is De Quervain’s Tenosynovitis Diagnosed?

Diagnosis usually starts with a detailed clinical examination of the wrist and thumb. The hand specialist evaluates for tenderness near the base of the thumb, swelling, restricted movement, and pain during thumb or wrist motion. The Finkelstein test may be used to help assess whether the symptoms are consistent with De Quervain’s tenosynovitis.

Observation of symptoms

A physical examination may be performed to check for swelling, tenderness, and restricted thumb or wrist movement. The clinical evaluation assesses where the pain occurs and whether daily actions such as gripping, lifting, or turning the wrist make symptoms worse.

Finkelstein test

The Finkelstein test is commonly used to evaluate suspected cases of De Quervain’s tenosynovitis. The thumb is folded across the palm, the fingers close over it, and the wrist is gently tilted toward the little finger. Pain experienced along the thumb side of the wrist during this manoeuvre may suggest irritation of the affected tendons.

Imaging studies

X-rays, ultrasound, or MRI scans may be considered if symptoms suggest another concurrent condition, such as local arthritis, an underlying fracture, ganglion cysts, or other structural problems in the wrist. Imaging is not always required and depends entirely on the clinical findings.

Treatment Options For De Quervain’s Tenosynovitis

Treatment for De Quervain’s tenosynovitis focuses on relieving pain, reducing inflammation, and improving function. Non-surgical options are usually tried first, with surgical treatment considered for persistent cases.

Non-Surgical Treatment

Rest and Activity Modification

Modifying repetitive thumb and wrist movements is generally recommended to reduce strain on the tendons. This can be achieved by altering daily activities or taking regular breaks during tasks. Rest is often supported by wearing a splint to keep the thumb and wrist stable.

Splinting

A thumb and wrist splint is used to stabilise the affected area and limit movement, reducing irritation to the tendons. The splint helps maintain the thumb in a comfortable position, allowing the tendons to recover.

Medications

Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can help manage pain and swelling. These medications are available over the counter or may be prescribed for short-term use to manage localised inflammation.

Corticosteroid Injections

A corticosteroid injection directly into the affected tendon sheath may help relieve pain and inflammation. In addition to managing swelling, the injection can help soften the tendon sheath, reducing friction in the area.

Surgical Treatment (Tendon Sheath Release)

For severe cases or when conservative measures are ineffective, a surgical procedure may be performed to release the tight tendon sheath. This creates more space for the tendons to move freely, aiming to reduce pain and improve function. The surgery involves a small incision near the affected area and is intended to restore movement, with many patients experiencing relief from symptoms, though individual results vary.

Recovery After De Quervain’s Treatment

Recovery depends on the severity of the condition and the treatment used. Mild cases may improve with rest, splinting, activity changes, or medication. After a corticosteroid injection, symptoms may ease over time, although response varies from patient to patient.

If surgery is required, your treating specialist will explain wound care protocols, hand use limitations, hand therapy needs, and the expected recovery timeline based on your condition and daily activities.

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Prevention and Management

To manage risk, it is helpful to avoid repetitive thumb and wrist movements and take regular breaks during activities that strain the hands. Maintaining an ergonomic wrist position during tasks, especially at work, can minimise stress on the tendons. Simple adjustments to daily routines, such as modifying lifting techniques or using ergonomic tools, can further help to reduce strain on the thumb tendons and prevent irritation.

Frequently Asked Questions

Does De Quervain’s tenosynovitis resolve without treatment?

In mild cases, the condition may gradually improve with sufficient rest and by avoiding activities that aggravate the symptoms. However, many cases benefit from timely medical intervention to support recovery.

Can De Quervain’s tenosynovitis recur after treatment?

Yes, the condition can recur if repetitive strain, improper hand and wrist positioning, or similar activities that caused the initial issue continue, even after successful treatment and recovery.

Can pregnancy-related cases resolve after childbirth?

Yes, in many instances, symptoms improve or resolve after breastfeeding ends, as the hormonal changes affecting the tendons settle and the physical strain of infant care activities, such as lifting, decreases.

What happens if De Quervain’s tenosynovitis goes untreated?

If left unmanaged, the pain and swelling can worsen, making simple tasks like holding a phone or typing more difficult. It may lead to long-term stiffness or chronic tendon strain. Many cases respond well to timely care. Consider arranging a consultation with a hand specialist to evaluate your symptoms.

How do you support recovery for De Quervain’s tenosynovitis efficiently?

The most reliable path toward relief is to obtain an accurate clinical diagnosis and start appropriate treatment early. For most people, this involves a combination of:

Resting the thumb and wrist by avoiding movements that trigger pain.
Wearing a custom splint to stabilise the area and allow inflammation to settle.
Seeking professional treatment, such as a corticosteroid injection, which may help reduce pain, with some patients noticing improvement within days, though individual timelines vary.

What should you avoid doing with De Quervain’s?

To prevent aggravating the pain, it is advisable to avoid:

Forceful gripping, pinching, or wringing motions.
Lifting heavy objects with your wrist in an awkward or unbalanced position.
Repetitive thumb movements, like scrolling or typing on a mobile phone, can cause pain.
Continuing an activity through persistent pain. If an activity hurts, it is best to pause.

What type of splint or brace is commonly used for De Quervain’s?

A commonly recommended option is a thumb spica splint. This type of brace supports the wrist and keeps the thumb still to let the affected tendons rest and heal. While generic splints are available, a custom-fitted splint from a hand therapist can offer better comfort and structural alignment.

What exercises help with De Quervain’s?

Important Note: Exercises should only be initiated once sharp pain has subsided, usually during the recovery phase. Starting too early may aggravate the condition. Gentle stretches, like slowly bending the wrist up and down or touching the thumb to each fingertip, can help restore movement later on. Your specialist or a hand therapist can advise on the right exercises for your stage of recovery.

Is a steroid injection for De Quervain’s painful?

Patients usually describe a quick pinch or sting during the injection, which is over in seconds. The injection itself often contains local anaesthetic to numb the area, and any discomfort is typically brief. For many, this brief discomfort is followed by a noticeable reduction in localised pain.

Is surgery for De Quervain’s a major operation?

No, it is generally considered a minor, low-risk procedure. It is typically performed as day surgery, often with local anaesthesia only, allowing patients to go home the same day. The surgeon makes a small incision to release the tight tunnel around the tendons, which is intended to relieve pressure and support improved movement. Tendon sheath release is generally considered a low-risk procedure, and many patients experience improved movement afterwards, though individual outcomes vary.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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