De Quervain's is inflammation of two thumb tendons where they pass through a tight tunnel on the thumb side of the wrist. It causes pain that is sharpest when you lift, wring or grip with the thumb, and it is common in new parents and in anyone who has recently increased how much they use their hands. Most cases settle with a splint, activity change and a corticosteroid injection. Where it persists, a short operation opens the tunnel. It takes 20 to 30 minutes as a day procedure and most people feel the relief quickly.
What is De Quervain's tenosynovitis?
Two tendons that move the thumb away from the hand run together through a narrow tunnel on the thumb side of the wrist, called the first extensor compartment. The tunnel is a fibrous roof over a groove in the bone, and it holds the tendons against the wrist as the thumb moves.
De Quervain's tenosynovitis is inflammation of these tendons in their compartment. The lining thickens, the tendons no longer glide easily through a tunnel that does not stretch, and every thumb movement becomes painful. Some people have a small extra septum dividing the tunnel into two, which makes the condition both more likely and harder to settle without surgery.
It is named after the Swiss surgeon who described it. It is not arthritis, and it is not a repetitive strain injury in the vague sense that phrase is usually used.
VIEW A VIDEO OF OUR DE QUERVAIN TENOSYNOVITIS CONSULT
Dr Paul van Minnen
Dr Nicholas Smith
Symptoms
Most people describe:
- Pain and swelling on the thumb side of the wrist, just above the wrist crease
- Sharp pain when lifting something with the thumb up, wringing out a cloth, or lifting a small child under the arms
- Pain that travels up the forearm or down into the thumb
- A creaking or catching sensation as the thumb moves
- Swelling, and occasionally a small firm lump over the tendons
- Weakness of grip, usually because gripping hurts rather than because the muscles are weak
The classic test is to tuck the thumb into a fist and bend the wrist towards the little finger. In De Quervain's this is sharply painful over the tendons. It is a useful test and not a perfect one, since arthritis at the base of the thumb can also hurt on the same manoeuvre.
Causes and risk factors
The folder lists overuse, some medications and hormonal changes. In more detail:
- A recent increase in hand use, particularly repeated lifting with the thumb out to the side. Lifting a baby is the archetype.
- Pregnancy and the months after childbirth. Common enough to have acquired the nickname mother's wrist. Fluid retention, hormonal change and a great deal of lifting arrive together.
- Sex and age. Much more common in women, most often between thirty and fifty.
- Some medications, including certain retroviral and cancer treatments.
- Inflammatory arthritis, and occasionally diabetes.
- Previous injury to the thumb side of the wrist.
Pregnancy related De Quervain's often settles once the hormonal changes resolve and the lifting reduces, which is a reason to be patient with it rather than to rush to surgery.
How it is diagnosed
By examination. Tenderness and swelling directly over the first extensor compartment, pain reproduced by the thumb tucked into a fist with the wrist deviated, and pain on resisted thumb movement are enough to make the diagnosis.
The main thing worth excluding is arthritis at the base of the thumb, which sits a centimetre or two away and is treated entirely differently. Where both are possible, or where the picture is atypical, an X-ray of the thumb base helps. Ultrasound is not routine, although it can show the thickened tendon sheath and identify a divided compartment where the diagnosis is in doubt.
Non-surgical treatment
Splinting and activity change
A thumb spica splint rests the tendons by holding the wrist and thumb still. Combined with changing the movements that provoke it, this settles a good proportion of early cases. It asks for several weeks of consistency.
Hand therapy
Our therapists fit the splint, adjust how you lift and carry, and progress you back to full use once the pain settles. In new parents this is mostly about finding a way to lift a child that does not load the thumb, which is more useful than being told to rest a hand you cannot rest.
Corticosteroid injection
An injection into the tendon compartment is effective in De Quervain's, more so than in many other tendon conditions, and for many people it resolves the problem in one. Where a divided compartment is present the injection has to reach both halves, which is one reason a proportion of injections fail. We arrange these under ultrasound guidance rather than injecting in the rooms, which makes reaching both halves far more likely. We would not repeat an injection more than twice in the same wrist.
What does not work
Anti-inflammatory tablets alone, ultrasound therapy and general wrist exercises do not settle it. Resting a hand that has to lift a baby every hour is advice rather than treatment, which is why the splint and the lifting technique matter more than the instruction to rest.
Surgery
De Quervain release surgery divides the roof of the compartment through an incision in the overlying skin, which creates space for the tendons to glide freely. In most cases swollen tissue around the tendons also needs to be removed, which is called a tenosynovectomy. Where the compartment is divided by a septum, both halves are opened, and finding that septum is a large part of why the operation is done under direct vision.
The procedure takes approximately 20 to 30 minutes and usually takes place as a day surgery procedure using sedation and a local anaesthetic. The incision is closed with resorbable skin sutures, and a tape bandage covers the wound under a soft hand and wrist dressing.
A short recovery
The soft dressing comes off on day 4 or 5, leaving only a tape bandage on the skin. Most people notice quick relief of symptoms and have recovered within the first two weeks.
Recovery, week by week
Indicative, and it varies.
Timeframe
What to expect
Day of surgery
Your thumb and some of your fingers may feel numb or tingly for one to three days because of the local anaesthetic. You can move your fingers and the tip of your thumb for light tasks before you leave hospital.
Days 1 to 5
Keep the soft dressing clean and dry. On day 4 or 5 you can remove the soft dressing, leaving the tape bandage on the skin intact. It is advised to see a hand therapist at this point to start exercises and to be fitted with a supportive wrist brace.
Days 5 to 14
The tape bandage can get wet in the shower or when you wash your hand. Dab it dry afterwards. If it separates you can replace or reinforce it with new tape. If you have a brace you can remove it to shower or for hand hygiene. Use the hand lightly as tolerated and avoid heavy tasks.
Two weeks
Your progress is reviewed by the doctor, hand therapist or practice nurse. If needed, a new tape bandage goes on for another three to five days. If you have a brace, you can stop using it at this point.
Two to four weeks
Most people notice quick relief and have recovered within the first two weeks. It is not abnormal for the area around the scar to stay tender or swollen for two, and sometimes four, weeks after surgery. Moisturising and massage of the area help.
Six weeks
A further follow up appointment if one is needed to monitor your progress.
Days 4 to 5 onwards
Most people are back to driving and to office and light work at four to five days. Light manual work generally follows at two to four weeks, and heavy work at four to six weeks.
Risks and complications
De Quervain release surgery is routine and safe, and complications rarely occur. When they do they can include:
- Wound healing problems or infection.
- Bleeding or bruising. Usually minor and settles on its own.
- Nerve injury. Branches of the superficial radial nerve cross directly over this compartment and give sensation to the back of the thumb. Injury or irritation causes numbness or an unpleasantly sensitive patch there, and it is the complication that matters most in this particular operation, but only very rarely occurs.
- Tenderness or swelling around the scar, or slower than expected recovery.
- Incomplete release, where a divided compartment was not fully opened and symptoms persist.
When to be seen sooner
Contact us, or see your GP, if you have:
- Pain on the thumb side of the wrist that has not settled after several weeks of splinting
- Symptoms returning after an injection, particularly a second time
- Numbness on the back of the thumb or index finger
- Pain that is waking you at night
- Sudden severe pain after an injury, rather than gradual onset
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
I have just had a baby. Will it settle on its own?
Often, yes. Pregnancy related De Quervain's tends to improve as the hormonal changes resolve and the pattern of lifting changes, so it is worth being patient with a splint and a different lifting technique before considering anything more. It does not always settle, and treatment is safe while breastfeeding, so being patient is not the same as putting up with it indefinitely.
Is this the same as arthritis of the thumb?
No, although the two are easily confused because both hurt near the base of the thumb. De Quervain's hurts on the side of the wrist and is provoked by moving the thumb. Thumb base arthritis hurts at the joint itself and is provoked by loading it, such as turning a key. They are treated completely differently, which is why the distinction is worth making properly.
How long does the operation take, and will I be awake?
Approximately 20 to 30 minutes, as a day surgery procedure using sedation with a local anaesthetic, so you will not feel the operation. You go home the same day.
Do I need my stitches removed?
The skin is closed with resorbable sutures, so they do not need removing. You are still reviewed at two weeks to check the wound and your progress.
When can I drive and go back to work?
Office and light work, usually four to five days, and most people are driving again at that point. Light manual work, two to four weeks. Heavy work, four to six weeks. There is no legislation covering surgery and driving, so the test is whether you can control the car safely, including in an emergency. We will give you a realistic estimate for your specific job before the operation, and a certificate.
Should I try an injection first?
For most people, yes. Injection works well in De Quervain's and often resolves it outright, and we arrange these under ultrasound guidance. Surgery is the answer where symptoms return, or where a divided compartment makes injection less likely to hold.
Will it come back after surgery?
Uncommon after a complete release. Where symptoms persist afterwards the usual explanation is that the compartment was divided by a septum and only one half was opened, which is why the operation is done under direct vision.
Will I have a numb patch afterwards?
The nerve giving sensation to the back of the thumb crosses directly over the area, so a small area of altered sensation around the scar is not unusual in the early weeks and usually settles. Persistent numbness is uncommon.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 9/9/2026