As a board-certified orthopedic surgeon and hand surgeon, I frequently encounter patients struggling with radial-sided (thumb) wrist pain. A common culprit behind the pain is an ailment known as De Quervain’s tenosynovitis. This inflammatory condition can significantly impact hand grip and, as a result, many activities of daily living.

Imagine the thumb as a master manipulator, essential for grasping, pinching and wielding objects. At its base, two crucial tendons, the abductor pollicis longus and extensor pollicis brevis, reside in a narrow tunnel in your wrist called the first dorsal compartment. These tendons are enveloped by a sheath that acts like a lubricant, ensuring smooth gliding during thumb movements.

De Quervain’s tenosynovitis disrupts your wrist’s harmonious system. Inflammation within the sheath narrows the space in the tunnel, causing friction and pain whenever the tendons move. This can be likened to squeezing a thick rope through a narrow tube—it doesn’t move smoothly.

The exact cause of De Quervain’s tenosynovitis remains elusive, but several factors can play a role:

• Repetitive Thumb Actions: Activities that involve repetitive grasping, pinching or twisting the wrist, such as gardening, using specific tools or playing racket sports, can overload the tendons, leading to inflammation.
• Hormonal Fluctuations: Pregnant and postpartum women are more susceptible due to hormonal changes that affect the tissues around the tendons.
• Direct Injury: A fall or blow to the wrist can sometimes trigger this condition.
• Underlying Inflammatory Conditions: People with rheumatoid arthritis or other inflammatory disorders may be more prone.

Read: How Some Sports Injuries Can Cause Arthritis at an Early Age

The most common symptoms are pain and tenderness at the radial side, the thumb side of your wrist. This pain often intensifies with gripping or pinching activities, such as holding a grocery bag or turning a doorknob. Other signs to watch out for include:

• Swelling over the thumb side of the wrist.
• Difficulty grasping or pinching objects secondary to pain.
• A positive “Finkelstein Test,” which is performed by: first, placing the thumb fully flexed into the palm; second, grasping the thumb with all remaining digits; finally, flexing the wrist towards the direction of the pinky finger, essentially putting the inflamed tendons on stretch. Pain at the base of the thumb along the bony bump on the thumb side of the wrist strongly suggests you have the condition.

De Quervain’s is predominantly a female condition because it is most commonly observed among new moms. Theories have been raised identifying postpartum hormonal changes, nursing activities, baby-lifting and baby-caring activities as potential causes. Given the high correlation between De Quervain’s patients and new motherhood, I believe each could play a role. The second largest group of patients we see for De Quervain’s includes patients who have been treated for breast cancer and are on Aromatase Inhibitor (AI) therapy. This group is also largely female.

Diagnosing De Quervain’s tenosynovitis typically involves a physical examination. Your physician will inquire about your symptoms and activities and perform tests to assess tenderness, swelling and the range of motion in your wrist and thumb. An ultrasound scan might be used to visualize the inflamed tendons and confirm the diagnosis, but most often a good physical exam will make the diagnosis clear.

The most common condition that can be confused with De Quervain’s is osteoarthritis at the base of the thumb. It shares similar features with De Quervain’s, but a careful exam and X-rays, if necessary, can distinguish the two.

Fortunately, De Quervain’s tenosynovitis often responds well to conservative measures:

• Rest: Avoiding activities that aggravate the pain is crucial for allowing the inflammation to subside. Immobilization with a splint or brace for a short period may be recommended.
• Ice Therapy: Applying ice packs for 15-20 minutes at a time, several times a day, can help reduce inflammation and pain.
• Anti-Inflammatory Medication: Over-the-counter oral medications such as ibuprofen or naproxen can manage pain and inflammation. Similarly, topical medications such as diclofenac can be used to reduce pain and inflammation. Because the tendons are just beneath the skin, this can be an effective method to treat the area without the possible side effects of oral medications, such as reflux.
• Corticosteroid Injection: Injections of cortisone directly into the inflamed area can relieve pain. However, these are typically limited due to potential side effects with repeated use.
• Hand Therapy: Exercises to strengthen the muscles around the wrist and thumb and improve flexibility can aid recovery and prevent future problems. An additional treatment performed by hand therapists called iontophoresis or phonophoresis are highly effective ways to treat De Quervain’s. These are electrical and ultrasound-assisted methods of getting medications, typically dexamethasone (a corticosteroid), into the area of the first extensor compartment.

If conservative measures fail to provide relief after a reasonable trial period, surgery might be considered. This outpatient procedure involves widening the first dorsal compartment to create more space for the tendons and alleviate pressure. This procedure takes less than 30 minutes to perform and has a short recovery period.

While not always preventable, here are some strategies to reduce your risk:

• Maintain Proper Form: If you perform repetitive hand and wrist movements, ensure proper technique to avoid strain.
• Take Breaks: Don’t overdo it. Take frequent breaks during activities that involve repetitive thumb movements.
• Strengthen Your Forearms: Exercises that strengthen the muscles in your forearm can improve wrist stability and reduce stress on the tendons.
• Listen to Your Body: Pay attention to any pain or discomfort in your wrist. Stop the activity and consult a specialist if symptoms persist.