What Is De Quervain's Tenosynovitis?
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. Specifically, it involves inflammation of the tendon sheaths surrounding the abductor pollicis longus and extensor pollicis brevis — the two tendons that control thumb movement. When these sheaths become inflamed and thickened, they constrict the tendons running through them, causing pain, swelling, and restricted movement at the base of the thumb.
Named after Swiss surgeon Fritz de Quervain who described it in 1895, this condition is commonly called "mommy thumb" because it frequently develops in new mothers who repeatedly lift infants with their thumbs extended. However, it affects anyone who performs repetitive pinching, gripping, or thumb-extension movements.
Causes and Risk Factors
- New parents — repeatedly lifting infants with the thumbs abducted
- Gardeners — repetitive gripping and tool use
- Golfers and racquet sport athletes — repetitive wrist and thumb loading
- Office workers and gamers — prolonged mouse use and repetitive thumb movements on devices
- Construction workers and tradespeople — heavy gripping and tool vibration
- Pregnancy and postpartum — hormonal changes increase tendon sheath inflammation
Diagnosing De Quervain's: The Finkelstein Test
The Finkelstein test is the classic diagnostic test for De Quervain's tenosynovitis. To perform it yourself:
- Make a fist with your thumb tucked inside your fingers
- Bend your wrist toward your little finger (ulnar deviation)
- A positive result is sharp pain at the base of the thumb along the wrist
If this test reproduces your pain, De Quervain's is highly likely. We confirm the diagnosis clinically and rule out other conditions including thumb CMC arthritis, intersection syndrome, and radial nerve entrapment.
Symptoms
- Pain and swelling at the base of the thumb, near the wrist
- Pain that worsens with pinching, gripping, or twisting motions
- Difficulty making a fist or holding objects
- A catching or snapping sensation when moving the thumb
- Tenderness along the first dorsal compartment of the wrist
Important distinction: De Quervain's pain is located at the base of the thumb near the wrist, not at the thumb joint itself. If the pain is at the joint, CMC arthritis should be evaluated instead.
Treatment
Activity Modification and Splinting
A thumb spica splint immobilizes the thumb and wrist, reducing inflammation and allowing the tendon sheath to calm. Activity modification — particularly avoiding the pinching and gripping motions that provoke symptoms — is essential.
Graston Technique
IASTM applied along the first dorsal compartment breaks down adhesions within the tendon sheath and reduces fibrotic tissue that restricts tendon gliding. It is one of the most effective conservative treatments for this condition.
Physical Therapy
Dr. Crockatt designs a graduated rehabilitation program including tendon gliding exercises, progressive loading, and ergonomic retraining to address the movement patterns contributing to the condition.
Suffering from De Quervain's Tenosynovitis?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
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