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Two tendons in one sheath
Two tendons are used in particular to spread and raise the thumb. They pass together in a small tunnel on the edge of the wrist, on the thumb side. In De Quervain syndrome, this passage becomes painful and the sliding of the tendons may be hampered.
We often speak of tendinitis or tenosynovitis. These words describe the affected area, but do not mean that all thumb pain is due to this mechanism. The joint at the base of the thumb and certain wrist bones are adjacent. Their treatment may be different, hence the interest in an examination when the pain persists or follows an accident.
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Understand the picture
The passage of the thumb tendons
Two tendons
They participate in the spacing and raising of the thumb.
Wrist sheath
The passage can become painful and hinder sliding.
Working thumb
Carrying and grasping stress this region, but also the neighboring joint.
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Actions that can become difficult
You may feel specific pain at the edge of the wrist, sometimes with swelling. Raising your thumb, grabbing scissors, opening a jar or carrying an object can increase it. The discomfort can move up into the forearm. Tendon catching is sometimes present, but not in everyone.
Carrying a baby under their arms with your thumbs widely apart can be particularly uncomfortable. This describes a solicitation, not a fault on your part. Specify which tasks are problematic and which are still possible. Pain at rest, loss of sensation or a clear blockage also deserves to be explained, because not everything necessarily comes from the tendon sheath.
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Enabling factors and uncertainties
The problem may appear without an obvious cause. It is observed in particular during the period around a birth. Hormonal changes and repetitive motions may contribute, but their exact role is not established for each person. Caring for a child alone is not a sufficient explanation.
Certain professional, domestic or sporting activities aggravate the pain without necessarily being the sole cause. Avoid concluding that your hand is damaged because you worked or used a phone. The most helpful thing is to identify what is increasing the symptoms and then find realistic alternatives that are compatible with your obligations and recovery.
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Situations that require another priority
Pain at the edge of the wrist after a fall may be due to a scaphoid fracture or other injury. Request an evaluation, even if the swelling appears moderate. A normal first x-ray does not always rule out this fracture; the indicated follow-up remains important.
A very red, hot and painful area with fever, a wound or discomfort requires a consultation the same day. A cold, pale or suddenly numb hand requires urgent help. New weakness or persistent loss of sensation should also be reported. Do not repeat stretches to try to check if the pain is truly De Quervain.
How the exam helps choose care
The clinician specifies the location of the pain, the movements concerned, progress over time and recent events. He examines the thumb, wrist and neighboring structures. Certain maneuvers can reproduce characteristic pain, but their interpretation depends on the overall examination.
It is not useful to jam the thumb in the fist and then pull the wrist strongly repeatedly at home. This procedure can be painful without confirming the diagnosis. An ultrasound or x-ray may be requested in certain situations, particularly if another cause is suspected. Imaging is not routinely neededally necessary when the clinical presentation is clear.
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Adapt actions and choose an splint
Temporarily reduce strong grips with your thumb wide apart. To carry, try using both hands, palms or forearm rather than a small grip between thumb and index finger. Alternate tasks when possible. The goal is to keep useful activities in a more bearable form.
An splint can support both the wrist and thumb. A simple band around the wrist does not always serve the same purpose. Specify the model and times of wearing. It should not compress the hand or cause new tingling. A medication or gel must be chosen with a professional, especially during pregnancy or breastfeeding.
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In everyday life
Rethinking a Painful Grip
Bring closer
Bring the object closer to the body before lifting it.
Distribute
Use two hands and a wider grip if it is comfortable.
Dose
Gradually return to repeated tasks and check the reaction the next day.
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Injection and operation: when to talk about it
Corticosteroid injection in the region of the sheath may be suggested to reduce symptoms. The clinician explains the expected benefit and the risks, such as a local reaction or a change in the skin. The decision depends on the progress, other care and your medical situation.
If the discomfort remains significant despite appropriate treatment, a surgical opinion can be discussed. The intervention aims to widen the passage of the tendons. It carries the risks of an operation, including scar pain, infection or irritation of small nerve branches. Relief and recovery are not guaranteed on a specific date; ask for the necessary instructions after the action.
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Physiotherapy and choice of exercises
The physiotherapist can help you observe the holds, distribute the efforts and gradually regain comfortable movements. When symptoms allow, strength work can be introduced with appropriate resistance. It is not a question of forcing the tendon to pass through its sheath nor of seeking maximum pain.
The movements in our exercises section serve as general guidelines. A thumb movement that markedly increases pain or leaves lasting discomfort should be reduced or suspended. The exercises do not replace a reassessment if hand use remains very limited. After injection or operation, follow the program and restrictions given by the team who treated you.
Carrying a child, working and sleeping
To lift a child, move closer to them, use both arms and look for a grip that avoids loading only the spread thumbs. Occasional help with the most irritating tasks can make recovery more feasible. These examples must respect the safety of the child and your own abilities.
At work or at home, change the way you hold a tool and break up long tasks. To sleep, look for comfortable support; If a night splint is planned, check that it does not create pressure. There is no obligatory position that heals the tendon sheath. Especially note the changes that really improve your comfort.
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Recovery and reassessment
Some mild forms improve within a few weeks; others remain annoying for longer. Progress is measured by the activities regained as much as by the sensitivity of the wrist. Avoid constantly pressing the area to check if it is still painful: this can lead to further irritation.
Gradually resume the holds, duration and loads, changing one element at a time. If the pain increases lastingly, return to a bearable stage. Seek medical advice if adaptations are not sufficient, if sleep and activities remain very disrupted or if new symptoms appear. Persistent pain merits rechecking the origin and plan of care.
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Your questions
Is it always linked to excessive phone use?
No. One use can awaken the pain without explaining the whole problem. Several factors can be involved and sometimes no clear cause is found. Adapt painful movements, but don't assume that a single object is responsible or that stopping completely guarantees recovery.
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Should I stretch my thumb strongly?
No. Stretches that strongly reproduce pain are not a mandatory step. Comfortable movement and appropriate progression are more useful than a repeated painful test. Ask what movements are appropriate for your situation.
Can I continue to carry my baby?
It depends on your comfort and ability to hold it securely. Try to distribute the weight between both arms and limit grips with your thumbs widely apart. If pain compromises safety, seek help and evaluation.
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Sources and references
- [1] BSSH: De Quervain’s syndrome
- [2] BSSH: Scaphoid fracture standards
- [3] NHS: Wrist pain
- [4] NHS Inform: Exercises for wrist, hand and finger problems
- [5] BSSH: Basal thumb arthritis
- [6] CGDIS · Appeler le 112
Text updated on
Medical review: awaiting Hasib Selimovic.