Why does my thumb hurt?

If you are feeling a nagging pain on the thumb side of your wrist, especially when gripping or twisting, you might be dealing with De Quervain’s tenosynovitis. This condition is a common type of tendon irritation, and while it can be quite uncomfortable, the good news is that there are effective treatments to help manage and relieve symptoms.

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is inflammation of the tendons that run along the thumb side of your wrist. Specifically, it affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons, which pass through a sheath at the base of your thumb. When these tendons become irritated or thickened, they struggle to glide smoothly, causing pain and swelling.

What causes De Quervain’s Tenosynovitis?

The exact cause isn’t always clear, but some common triggers include:

• Repetitive motions: Activities like typing, texting, gaming, or lifting a baby can strain the tendons.

• Overuse: Any repetitive hand or wrist movement that involves gripping or twisting, such as gardening or sewing.

• Injury: Trauma to the wrist or thumb can lead to inflammation.

• Hormonal changes: Pregnancy and postpartum are common times for De Quervain’s due to fluid retention and repetitive baby care tasks.

• Arthritis: Underlying conditions like rheumatoid arthritis can contribute to tendon irritation.

How do you know if you have De Quervain’s?

The most common signs and symptoms include:

• Pain and tenderness: Felt on the thumb side of your wrist, especially during movements like gripping, pinching, or twisting.

• Swelling: Normally around the base of the thumb.

• Difficulty moving the thumb: Stiffness or a “sticking” sensation.

• Painful grip strength: Tasks like opening jars or lifting objects can become challenging.

• Finkelstein’s test: We might ask you to make a fist with your thumb tucked inside your fingers and then bend your wrist towards your pinky. If this movement causes sharp pain, it’s a strong indicator of De Quervain’s.

What can you do about thumb pain from De Quervain’s?

Treatment depends on the severity of your symptoms but typically starts with conservative options:

1. Rest and Activity Modification. Avoid or reduce repetitive activities that strain your wrist and thumb. Use ergonomic tools like an ergonomic mouse to minimize stress on the area.

2. Splinting. Wearing a thumb splint can immobilise the thumb and wrist, reduce movement and allow the tendons to rest and heal.

3. Ice Therapy. Apply an ice pack to the affected area for 5 to 10 minutes to reduce pain and swelling.

4. Anti-inflammatory Medications. Over-the-counter NSAIDs (like ibuprofen) can help reduce inflammation and pain.

5. Corticosteroid Injections. In more severe cases, your GP might recommend a corticosteroid injection to reduce inflammation and provide quick relief.

6. Surgery. If conservative treatments don’t work after several months, surgery might be needed. This involves releasing the sheath around the inflamed tendons to allow for smoother movement.

How can physiotherapy help De Quervain’s?

Physiotherapy plays a crucial role in managing De Quervain’s Tenosynovitis and preventing recurrence. We may use manual therapy, ultrasound, or TENS (transcutaneous electrical nerve stimulation) to help with the pain and reduce swelling. Hands-on techniques like massage can help release tension and improve tendon mobility. We may suggest modifications to your daily activities or ergonomic advice to reduce repetitive strain.

Gentle stretches for the thumb, wrist, and forearm can improve flexibility and reduce tension in the tendons. Strengthening the muscles around the wrist and thumb can improve stability and reduce strain on the tendons.

Wrist extension stretch

• Extend your arm with your palm facing up.

• Use your other hand to gently pull your wrist and thumb down so your fingers point towards the floor.

• You should feel a stretch through your wrist and forearm.

• Hold for 10–15 seconds.

• Repeat 3 times.

Thumb Strengthening Exercise

• Hold a lightweight object (or a small can of beans or soup) in your hand.

• Slowly push your thumb across the object and back to the starting position.

• Hold the position for 5 seconds. Repeat 10–15 times once a day.

If your symptoms persist for more than a few weeks or interfere with daily activities, it might be time to consult a healthcare provider. Early intervention can prevent the condition from worsening and reduce the likelihood of needing invasive treatments.

De Quervain’s tenosynovitis can be frustrating, especially if it limits your ability to do everyday tasks. But with the right combination of rest, treatment, and physiotherapy, recovery is very achievable.

If you’re experiencing pain on the thumb side of your wrist, don’t wait—seek advice. At First Line Physio, we can guide you through tailored exercises and strategies to get you back to doing what you love, pain-free.

 This is absolutely not written to substitute medical advice and it is always important to see a qualified healthcare professional for a formal diagnosis. If any of the exercises cause pain during or after the exercise, discontinue and consult a physiotherapist.  

If you would like to get in touch please visit our contact page.