De Quervain’s Tenosynovitis

September 19, 2026

Understanding the Condition and the Role of Physiotherapy in Recovery

If you feel pain on the thumb side of your wrist whenever you hold your phone, open a jar, lift a kettle, carry a shopping bag, or pick up a child, you may be dealing with De Quervain’s Tenosynovitis.

This is a condition that I see quite regularly in my clinic. Some patients come thinking they have a wrist sprain, while others believe the pain is coming from the thumb joint itself. After a proper assessment, we often find that the real problem lies within the tendons that control thumb movement.

Many patients tell me:

“Doctor, my wrist hurts whenever I grip something.”

“I cannot comfortably lift a cup of tea anymore.”

“Even holding my phone for a long time makes the pain worse.”

One thing I have noticed in many patients is that they keep using the painful hand because the discomfort initially seems minor. By the time they seek treatment, even simple daily activities have started becoming difficult.

The good news is that most people recover well when the condition is recognized early and treated properly.

Understanding the Anatomy

Before discussing the condition, let me explain the area involved.

On the thumb side of your wrist, there are two important tendons:

Abductor Pollicis Longus (APL)
Extensor Pollicis Brevis (EPB)

These tendons help move and control the thumb during gripping, lifting, pinching, writing, and many other hand activities. They travel through a small tunnel near a bony area called the radial styloid.

I usually explain this to patients in a simple way:

“Imagine two ropes passing through a narrow tunnel. If those ropes are repeatedly pulled and rubbed day after day, the tunnel becomes crowded and movement becomes painful.”

That is essentially what happens in De Quervain’s Tenosynovitis.

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist.

The tendon sheath surrounding the APL and EPB tendons can become irritated and thickened, making it difficult for the tendons to glide smoothly during movement. As a result, pain can develop whenever the thumb or wrist is used.

The condition usually develops when the thumb and wrist are repeatedly exposed to activities that aggravate the affected tendons.

What Causes De Quervain’s Tenosynovitis?

There are several possible contributing factors.

Common causes and aggravating activities include:

Repeated gripping activities
Frequent thumb movements
Long hours of mobile phone use
Lifting children repeatedly
Repetitive household work
Gardening
Gym activities
Repeated twisting movements
Occupations requiring constant hand use
A sudden increase in hand activity levels

In my clinic, I frequently see this condition in new mothers, office workers, gym members, and people whose jobs require constant hand and thumb movements.

Repetitive hand and wrist activities can also contribute to other wrist problems, as explained in our guide to Wrist Pain.

Common Symptoms

The symptoms can vary from person to person, but some complaints appear repeatedly.

Patients often tell me:

“Doctor, the pain is right here beside my thumb.”

“Opening a bottle has become difficult.”

“I feel pain whenever I lift something.”

Common symptoms include:

Pain on the thumb side of the wrist
Tenderness over the affected area
Pain during gripping
Pain while lifting objects
Pain when twisting door handles
Pain during pinching activities
Mild swelling near the thumb side of the wrist
Clicking or snapping sensation in some cases
Weak grip due to pain
Difficulty performing daily activities

One thing I have observed in many patients is that activities such as lifting a kettle, opening jars, carrying grocery bags, or holding a baby often become surprisingly painful.

How is De Quervain’s Tenosynovitis Diagnosed?

Diagnosis usually begins with a detailed history and physical examination.

As physiotherapists, we assess:

Pain location
Thumb movement
Wrist movement
Grip strength
Functional activities
Work demands

Special clinical tests may include:

Finkelstein Test

This is one of the commonly used clinical tests for reproducing symptoms associated with De Quervain’s Tenosynovitis.

Eichhoff Test

This is another test that may reproduce pain around the thumb side of the wrist.

WHAT Test

The Wrist Hyperflexion and Abduction of the Thumb (WHAT) test may also be used during assessment.

If necessary, doctors may request imaging such as:

Ultrasound
MRI
X-rays to help rule out other conditions

Why Physiotherapy is Important

Many patients ask me:

“Doctor, should I completely stop using my hand?”

The answer is usually no.

The goal is not to stop moving forever. The goal is to calm the irritated tendons, improve their movement, restore strength, and gradually return you to normal activities.

Physiotherapy may help:

Reduce pain
Reduce tendon irritation
Improve thumb mobility
Improve wrist mobility
Restore strength
Improve grip function
Improve daily activities
Reduce the risk of recurring symptoms

I have seen many patients improve once they understand which activities are irritating the tendons and begin following a structured rehabilitation program.

Physiotherapy Goals

When treating De Quervain’s Tenosynovitis, our goals are:

Reduce pain
Reduce tendon irritation
Improve thumb mobility
Improve wrist mobility
Restore grip strength
Improve hand function
Return to normal activities
Reduce future flare-ups

Physiotherapy Treatment Protocol

Phase 1: Pain Reduction and Protection Phase

Goals

Reduce pain
Calm irritated tendons
Prevent further irritation

Activity Modification

The first thing I usually discuss with patients is identifying activities that increase their symptoms.

Examples include:

Repeated thumb movements
Heavy gripping
Forceful pinching
Repetitive lifting
Excessive mobile phone use

Reducing or modifying aggravating activities can give the affected area time to settle while rehabilitation begins.

Ice Therapy

Cold packs may help reduce pain and irritation after activities. They should be used appropriately and should not be applied directly to the skin.

Thumb Spica Splint

Some patients may benefit from a thumb spica splint, which supports the thumb and wrist while allowing the irritated tendons to settle.

Gentle Mobility Exercises

I usually begin with gentle exercises such as:

Wrist Flexion and Extension
Thumb Flexion and Extension
Thumb Opposition
Gentle Thumb Abduction

The purpose is to maintain movement without aggravating symptoms.

Phase 2: Mobility and Tendon Gliding Phase

Goals

Improve tendon movement
Reduce stiffness
Restore mobility

Thumb Tendon Gliding Exercise

This can be included as part of a gradual rehabilitation program to encourage comfortable thumb movement.

Thumb Opposition Exercise

This exercise helps improve thumb coordination and movement.

Thumb Abduction Exercise

This helps restore comfortable thumb movement and function.

Wrist Range of Motion Exercises

Gentle wrist movements can help maintain flexibility and mobility.

Thumb Web Space Stretch

A gentle stretch that may be useful for patients experiencing tightness around the thumb web space.

I often tell patients that this phase is about gradually teaching the tendons to move comfortably again.

Phase 3: Strengthening Phase

Goals

Improve tendon strength
Restore grip power
Improve endurance

This phase is where many patients begin noticing improvement in daily activities.

Strengthening Exercises

Isometric Thumb Abduction

A gentle way to begin strengthening the muscles involved in thumb movement.

Isometric Thumb Extension

Helps activate the muscles involved in thumb extension.

Soft Ball Squeeze Exercise

Can be used to gradually improve grip strength when gripping is comfortable.

Therapy Putty Exercises

Useful for progressive hand and thumb strengthening.

Rubber Band Thumb Abduction

Targets the muscles that support thumb movement.

Thumb Extension with Resistance Band

Provides progressive strengthening as tolerance improves.

Wrist Radial Deviation Exercise

Strengthens muscles involved in movement on the thumb side of the wrist.

Eccentric Thumb Control Exercises

These may be introduced during later stages of rehabilitation when appropriate.

In my clinic, I have seen many patients regain confidence once gripping, lifting, and holding objects becomes comfortable again.

Phase 4: Functional and Return-to-Activity Phase

Goals

Restore normal hand function
Improve endurance
Return to work and daily activities

Exercises may include:

Functional gripping drills
Lifting practice
Carrying exercises
Household task simulation
Work-specific hand activities
Gym-specific rehabilitation

At this stage, we gradually prepare the hand and wrist for real-life demands.

Manual Therapy Techniques

Depending on the patient’s condition, physiotherapy may also include:

Soft Tissue Mobilization
Myofascial Release
Tendon Mobilization
Joint Mobilization
Trigger Point Release

These techniques are usually combined with exercise rather than used alone.

Home Exercise Program

I always remind my patients that recovery does not happen only during clinic visits.

A simple home program may include:

Thumb Tendon Gliding
Thumb Opposition Exercise
Thumb Abduction Exercise
Thumb Web Space Stretch
Soft Ball Squeeze Exercise
Therapy Putty Exercises
Wrist Mobility Exercises

The key is consistency rather than doing too much too quickly.

If an exercise significantly increases pain, numbness, swelling, or other symptoms, stop the exercise and discuss it with a qualified healthcare professional.

Recovery Time and Prognosis

One of the most common questions I hear is:

“Doctor, how long before the pain goes away?”

The answer depends on several factors, including:

Severity of the condition
Duration of symptoms
Daily activity demands
Response to treatment
Consistency with the rehabilitation program

Recovery time can vary considerably between individuals. Mild cases may settle over several weeks, while more persistent symptoms can require a longer period of rehabilitation.

From my clinical experience, patients who follow their exercise program, modify aggravating activities, and avoid repeatedly irritating the tendon often make better progress.

If symptoms continue despite conservative treatment, or if pain and functional limitations become severe, a medical assessment may be appropriate to discuss other treatment options.

Final Thoughts

De Quervain’s Tenosynovitis may start as a small pain near the thumb, but it can quickly begin affecting simple activities such as holding a phone, lifting objects, opening jars, writing, or carrying groceries.

As a physiotherapist, I have seen many patients become frustrated because the pain interferes with so many everyday tasks. The encouraging part is that many people improve with a combination of education, activity modification, physiotherapy, and a structured exercise program.

If you have pain on the thumb side of your wrist that has been bothering you for weeks, do not ignore it. Early assessment can help identify the cause of your symptoms and guide an appropriate treatment plan.

With the right guidance, patience, and consistent rehabilitation, many people can regain comfortable thumb movement, restore hand function, and return to their daily activities.

This article is for educational purposes and should not replace professional medical advice.

Written by Dr Areej Nadeem PT
College of Physiotherapy
JPMC Karachi