Physiotherapy and the Management of De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It results from inflammation of the sheath surrounding the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons as they pass through a fibrous tunnel near the radial styloid. Physiotherapy plays a central role in the conservative management of this condition, focusing on reducing pain, restoring function, and preventing recurrence. This article explores the causes, symptoms, and physiotherapeutic treatment strategies for De Quervain’s tenosynovitis.

Understanding De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is often caused by repetitive wrist and thumb movements, making it common among individuals engaged in activities such as texting, typing, lifting, and even caring for infants — hence the nickname “mother’s thumb.”

Common causes and risk factors include:

• Repetitive strain: Tasks involving frequent gripping, pinching, or wringing actions.
• Overuse injuries: Sports, manual labour, or prolonged use of handheld devices.
• Postpartum changes: Hormonal shifts and lifting infants can contribute to onset.
• Inflammatory conditions: Rheumatoid arthritis or other systemic inflammation may increase risk.

Symptoms may include:

• Pain and swelling near the base of the thumb
• Difficulty gripping or pinching
• Pain when turning the wrist or lifting objects
• Positive Finkelstein’s test (pain with ulnar deviation while grasping the thumb)

Physiotherapy Treatment Methods for De Quervain’s

Pain Management and Inflammation Reduction

During the acute phase, physiotherapists aim to reduce pain and swelling using:

• Cryotherapy (cold packs)
• Ultrasound therapy
• Taping or bracing (thumb spica splint to rest the tendons)

These interventions help minimise tendon irritation and prepare the area for movement-based therapy.

Manual Therapy

Manual techniques may include:

• Soft tissue mobilisation
• Myofascial release
• Joint mobilisations of the wrist and thumb

These help reduce adhesions, improve tendon gliding, and relieve muscular tension.

Stretching and Tendon Gliding Exercises

Gentle range-of-motion exercises are introduced as pain decreases. Tendon gliding routines and stretches targeting the APL and EPB help restore mobility and reduce stiffness.

Strengthening and Load Management

Once inflammation subsides, progressive strengthening exercises for the wrist, thumb, and forearm improve resilience. Focused routines using resistance bands, putty, or light dumbbells target extensor and abductor muscles, ensuring controlled tendon loading.

Activity Modification and Ergonomics

Physiotherapists provide education on:

• Modifying tasks to reduce strain
• Ergonomic adjustments in the workplace or home
• Avoiding aggravating motions such as repetitive lifting or twisting

Patient Education and Self-Management

Empowering patients through education is a key physiotherapy goal. Individuals are guided to:

• Recognise symptom triggers
• Use correct wrist mechanics
• Follow a personalised home exercise programme to maintain long-term function

Conclusion

De Quervain’s tenosynovitis can significantly impair hand and wrist function, but a structured physiotherapy programme can alleviate symptoms and restore daily performance. Through a combination of manual therapy, targeted exercises, ergonomic advice, and education, physiotherapists help individuals recover and prevent future flare-ups.

If you’re experiencing wrist pain or limited thumb mobility, don’t wait — early intervention can make a big difference. Contact our physiotherapy team today to book an assessment and start your path to recovery.

References

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