De Quervain’s Thumb Tendinitis

ΠΕΡΙΕΧΟΜΕΝΑ

The use of our hands and especially the thumb is fundamental for almost every activity of our daily life, from holding a cup to typing on a smartphone or lifting a child. The freedom of movement of the thumb is secured by a complex system of tendons, which function like ropes transferring power from the forearm muscles to the fingers. When these tendons are overloaded and become inflamed, daily life can turn into an exceptionally painful experience.

One of the most characteristic and agonizing conditions of this region is De Quervain’s Tendinitis (or Syndrome). This syndrome took its name from the Swiss surgeon Fritz de Quervain, who described it for the first time in 1895, and until today constitutes one of the most frequent reasons for visiting specialized upper limb orthopedics.

What is thumb tendinitis or de Quervain’s tendinitis?

De Quervain’s tendinitis is an exceptionally common, inflammatory condition that is particularly painful, as two specific tendons of the thumb – which are responsible for the extension (opening outward) and abduction of the thumb – are affected by intense inflammation and thickening.

To understand the mechanism of the condition, we must know a few things about the anatomy of the wrist. The tendons that move the fingers are not loose under the skin. In order to function properly and not bowstring outward, they pass through narrow tunnels called sheaths. The sheath is a protective lining containing lubricating fluid.

In the region of the wrist, exactly at the base of the thumb (in the first dorsal compartment), two specific tendons pass together through a very narrow, common tunnel:

The extensor pollicis brevis
The abductor pollicis longus.

When these tendons overuse, friction is created. Friction causes inflammation, which in turn makes the sheath (the tunnel) swell, thicken, and become narrower. Simultaneously, the tendons themselves enlarge. This specific tendinitis constitutes, therefore, a preeminent syndrome of overuse and entrapment, as the enlarged tendons are “strangled” and trapped within their narrow tunnel every time the patient attempts to move the thumb, causing intense, piercing pain.

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What are the causes of thumb tendinitis?

The main cause of de Quervain’s disease is chronic overuse of the wrist and thumb. Every movement involving repetitive grasping, squeezing, twisting, or bending of the wrist can irritate the sheath of the tendons.

The main causes and risk groups include:

New Mothers and Pregnancy (“Baby Thumb”): The condition is exceptionally common in new mothers (often appearing 4-6 weeks after delivery). This occurs due to the abrupt, repetitive movement where the mother lifts the baby putting her thumbs under its armpits, with the wrists bent downward. In addition, hormonal changes during pregnancy and breastfeeding cause fluid retention, narrowing the sheaths even more.
Use of Mobiles and Computers (“Smartphone Thumb”): In the modern era, the condition presents a vertical increase due to the constant and repetitive use of the thumb (scrolling/texting) on the touch screens of smartphones, but also the use of a mouse in office jobs with wrong ergonomics.
Manual Labor: Excessive use of the thumb in intense manual labor (carpenters, plumbers) that requires squeezing tools or repetitive rotational movements.
Sports Activities: Sports requiring a racket (tennis, padel) or golf.
Age and Gender: It makes its appearance much more frequently in middle-aged women (30-50 years old).
Systemic Conditions: Patients suffering from rheumatoid arthritis are much more prone, as the disease causes generalized inflammation in the synovia (synovitis). Direct injuries or previous fractures in the wrist may also create scars that restrict the movement of the tendons.

What are the symptoms of thumb tendinitis?

De Quervain’s disease does not go unnoticed. It causes a characteristic, intense pain and tenderness along the side of the thumb at the wrist (where we usually feel our pulse), which often radiates upward (to the forearm) or downward, into the thumb itself. The pain is usually triggered or worsens:

During movement of the thumb or when opening it abruptly backward.
Forming a fist.
Grasping, squeezing, or “pinching” something tightly (e.g., when opening a jar or turning a key).
During rotation of the wrist (e.g., when pouring water from a pitcher or wringing clothes).
Lifting weights: Especially lifting something with the hands forward and the thumbs turned upward (the classic gripping of a baby or a stack of books).

Apart from pain, other accompanying symptoms are:

Edema (Swelling): You might notice a visible, hard lump or swelling at the base of the thumb, which is exceptionally tender to pressure.
“Catching”: A feeling of catching, friction, or a characteristic “click” as you move the thumb, due to the tendons having difficulty passing through the narrow sheath.
Night Pain: Significant night pain (like a deep burning sensation) that keeps the patient awake or does not let them sleep.
Stiffness: With the passage of time, if left untreated, the sufferer cannot execute delicate movements with the hand and the range of motion of the thumb and wrist gradually decreases due to pain.

Clinical examination and diagnosis of thumb tendinitis

The patient with this specific condition needs evaluation and management by an experienced and specialized upper limb surgeon, in order to avoid a wrong diagnosis (e.g., not to confuse it with arthritis at the base of the thumb or carpal tunnel syndrome).

Mr. Polyzois will see you at his clinic and take your detailed specific medical history. Subsequently, he will examine you carefully, palpating the area. The most classic and reliable clinical test used worldwide for diagnosis is the Finkelstein / Eichhoff Test:

The doctor will ask you to fold your thumb inside your palm and close your remaining four fingers tightly over it, forming a fist.
Then, he will ask you to bend your wrist abruptly downward (toward the side of the little finger).
If this movement causes intense, piercing pain at the base of the thumb, the test is positive and confirms the diagnosis of de Quervain.

The diagnosis is primarily clinical. However, the doctor might send you for plain X-rays to rule out other accompanying conditions (such as osteoarthritis or old scaphoid fractures). A Diagnostic Ultrasound or a Magnetic Resonance Imaging (MRI) are useful only in complex, persistent cases to check the exact size of the inflammation, the amount of fluid within the sheath, or anatomical abnormalities (such as the existence of a dividing septum inside the sheath, which makes conservative treatment difficult).

Conservative treatment of thumb tendinitis

When the diagnosis is made timely, the condition can be treated effectively without surgery. Conservative treatment aims at reducing inflammation, decompressing the tendons, and preventing recurrence. The plan usually includes:

Rest and Modification: Avoidance of movements that trigger the pain (e.g., pause from jobs requiring strong squeezing, change in the way you lift the baby). Active rest is the first and perhaps the most difficult step, given the necessity of the hands.
Splinting: Use of a specific ergonomic immobilization splint (Thumb Spica Splint). This splint encompasses the wrist and thumb, holding them in a straight, neutral position. It prevents the tendons from moving and rubbing inside the sheath, allowing the inflammation to subside. It must be worn systematically (and at night) for 3-4 weeks.
Medication & Ice: Use of specific non-steroidal anti-inflammatory drugs (NSAIDs), either by mouth (pills) or in the form of a topical gel, for a short period of time during the acute phase of pain. Also, placing ice on the area immediately reduces swelling.
Physiotherapy: A specific program of Physiotherapy and a program of stretching exercises at home (which will be personalized by Mr. Polyzois and his associates) help in strengthening and the elasticity of the area, once the acute pain subsides.
Cortisone Injections: They constitute the most drastic conservative solution when the above do not yield. Mr. Polyzois performs specific infiltrations of a steroid (cortisone) and local anesthetic exactly around the tendons (inside the sheath). The injection dramatically reduces the swelling of the tissue. In many cases (especially in new mothers), one or two injections definitively solve the problem. However, in chronic situations, relief may be temporary for a limited period of time (a few months) and certainly does not constitute a long-term and definitive solution if the problem is strictly anatomical.

Surgical treatment of thumb tendinitis

When symptoms are very intense, last for more than 4-6 months despite aggressive conservative treatment, or if the pain returns quickly after the cortisone injection, surgical intervention is deemed necessary.

The surgical operation (Opening of the 1st Dorsal Compartment), performed by Mr. Polyzois, offers the absolute and definitive solution to the problem, with an excellent aesthetic and functional result. The purpose of the operation is to create more space for the tendons, so they are not pressed.

The Procedure (Minimally Invasive MIS):

Mr. Polyzois releases and mechanically decompresses the suffering tendons. This is achieved through the division (opening) of the tight sheath that functions as a “ring” around them.
This is performed with a microsurgical technique, through a very small incision up to 2 centimeters, on the side of the wrist, from the side of the base of the thumb.
The doctor takes care to locate and fully open all the small, internal septa (sub-compartments) that might “imprison” individually the various parts of the tendons (one of the most frequent causes of failure in the hands of non-specialized doctors), while protecting with absolute safety the sensitive superficial radial nerve of the area.

Advantages and Rehabilitation:

The surgery is very fast and lasts approximately 10-15 minutes.
The anesthesia is local. The patient is awake (Awake Surgery), avoiding general anesthesia.
The operation is entirely bloodless, painless, and has a success rate reaching 100%.
Hospitalization is a day case (Day Clinic). The patient returns home a few hours later with a simple, light dressing for 24-48 hours.
When the dressing is removed, the patient moves and uses their hand and thumb immediately, normally and without any restriction, as the pain has now vanished. Returning to full activities is usually completed in 2-3 weeks (after the healing of the small incision).
The cost of the operation is quite affordable, due to the speed and the avoidance of multi-day hospitalization.

A Few Words About the Doctor (Dr. Polyzois)

The surgical management of de Quervain, even though it is short, requires the absolute specialization of an upper limb surgeon, as the wrist region is full of superficial, sensitive nerves.

We remind you that Orthopedic Surgeon Mr. Ioannis Polyzois possesses 20 years of surgical and clinical experience in Great Britain and 10 years of experience in the position of permanent Director (substantive Consultant) in the National Health System (NHS) in London. He constitutes the only Orthopedic surgeon in Greece with this certified prior service in shoulder and upper limb surgery.

He is fully certified at all levels, with thousands of successful hand surgeries to his credit. Our team’s approach is characterized by scientific excellence, deep empathy for the patient’s needs, and constitutes a guaranteed, personalized solution to each patient’s separate problem, no matter how simple or complex it may be. In any case, do not hesitate to contact Mr. Polyzois and his team for any questions or concerns you may have.

Movement is life! Contact the doctor for specialized orthopedic care, tailored to your needs.

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Συχνές ερωτήσεις

Can de Quervain’s tendinitis appear in both hands?

Yes, it is extremely common for the condition to appear bilaterally, meaning in both wrists (or to be “transferred” from one to the other). This is observed most frequently in new mothers, as they use both their hands in the exact same wrong mechanical way to lift the baby from the crib. Also, individuals who heavily use the keyboard or smartphones with both thumbs simultaneously (texting) burden both limbs equally. In case surgery is needed in both hands, operations are often scheduled with a difference of a few weeks so that the patient does not lose their full independence.

How long does the condition usually last without treatment?

If ignored, de Quervain’s disease does not have a specific “expiration date”. In new mothers (where the cause is often temporary due to hormones and change of activity), the condition can run its course and improve gradually 6 to 12 months after delivery or after the cessation of breastfeeding. However, in most people, provided the cause of strain is not removed and treatment is not administered, the inflammation tends to become permanent (chronic tendinopathy). The pain becomes established and the sheath thickens to a degree that scar tissue creates irreversible damage, rendering surgery a one-way street.

Can it affect my work?

Absolutely, and it often does to a dramatic degree. Because the thumb is responsible for the ability to grasp and handle objects (Grip and Pinch), the piercing pain prevents even the simplest tasks. Depending on your profession, you might find it difficult (or impossible) to hold a pen, type, hold tools (scissors, keys), lift weights, or drive. Frequently, taking sick leave is required in acute stages or immediate ergonomic intervention in the workplace to be able to continue working without excruciating pain.

Is the use of a mobile phone safe?

In this day and age, excessive use of the mobile phone is considered one of the main “culprits” for the rapid increase of the condition in young people (which is why it is often referred to as “smartphone thumb”). The movement of holding the heavy smartphone with one hand (while the wrist is bent) and simultaneously extending the thumb to scroll or write directly and constantly burdens the two tendons of de Quervain. It is recommended to use the mobile with both hands (holding the device with one and using the index finger of the other hand), using voice messages, and, in general, drastically reducing the device’s usage time (screen time).

Is there a risk of permanent damage?

If the condition is neglected for too long a period of time (e.g., over a year), the body, in its attempt to heal the chronic inflammation, creates thick scar tissue around the tendons. This causes permanent stiffness and a noticeable reduction in the wrist’s range of motion. Additionally, due to the patient avoiding using the thumb so as not to hurt, significant muscle atrophy (thinning) comes upon the muscles of the palm. In some rare cases of chronic friction, the tendons themselves weaken and there is a risk of undergoing a partial or complete tear (being cut), a situation requiring a much more complex reconstructive surgery. That is why a timely conservative or minimally invasive surgical solution permanently protects your hand.

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