De Quervain’s Tenosynovitis: who to see and what helps

De Quervain’s Tenosynovitis · Kitchener, Waterloo & Cambridge

De Quervain’s tenosynovitis is pain on the thumb side of the wrist, where two thumb tendons pass through a tunnel. Mild cases can settle in a few weeks with rest and a thumb splint; when that is not enough, the treatment with the best evidence is a steroid injection from a physician, combined with a splint. Physiotherapy is the CARESPACE service for it, and a physiotherapist assesses and treats on the first visit.

What De Quervain’s tenosynovitis is

Two of the tendons that move the thumb run side by side through a tunnel on the thumb side of the wrist. In De Quervain’s the lining of that tunnel thickens and the tendons become trapped, so moving the thumb or wrist hurts. Despite the “-itis” in the name, it is put down to thickening and wear of the tendon lining more than to acute inflammation. You may also see it called De Quervain’s syndrome or De Quervain’s disease.

Symptoms of De Quervain’s

• Pain on the thumb side of the wrist, worse when you lift the thumb as if hitchhiking, use scissors, pinch, or twist the wrist
• Tenderness when you press on the spot
• Swelling on that side of the wrist, easiest to see by comparing it with the other wrist
• Occasional clicking, snapping or creaking as the thumb moves
• Pain that can spread up the forearm or into the thumb, and sometimes numbness on the back of the thumb and index finger

What causes De Quervain’s

Often there is no obvious cause. Mothers of small babies seem especially prone, and it is not clear whether that is down to hormonal changes after pregnancy or to lifting the baby again and again. Pregnancy, diabetes and rheumatoid arthritis raise the risk, and it is most common in women, from their 30s into their 50s. Wringing out clothes, hammering, knitting and skiing are other triggers. There is little evidence that work causes it, but hand use at work, in sport or in the garden can aggravate it, and in Waterloo Region that includes a spring of planting and pruning.

How De Quervain’s is diagnosed

Usually by examination. In the Finkelstein test you make a fist with the thumb tucked inside and bend the wrist toward the little finger; pain on the thumb side of the wrist points to De Quervain’s. Look-alikes include arthritis at the base of the thumb, tendon irritation further up the forearm and, after a fall, a break in the scaphoid bone. It is not carpal tunnel syndrome, which causes numbness and tingling in the fingers, or trigger finger, which causes clicking and tenderness in the palm at the base of a finger.

When wrist and thumb pain needs urgent care

For thumb pain, the UK’s NHS says to go to an urgent treatment centre or A&E, which in Ontario means an urgent care clinic or an emergency department, if you:

• have severe pain, or feel faint, dizzy or sick from the pain
• heard a snap, grinding or popping noise at the time of an injury
• cannot move your thumb or hold things
• have a thumb that has changed shape or colour
• have lost the feeling in part or all of your hand

These can be signs of a broken thumb. The NHS’s wrist advice adds two reasons to get urgent advice the same day: a lump on the wrist that is very painful, hot or red, and feeling unwell, hot, cold or shivery along with the pain.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating De Quervain’s

• Where this comes from. Mainly a 2023 systematic review of 30 trials (1,663 people, 80% of them women), with guidance from British hand surgeons. The review rated its evidence as low certainty for pain and moderate for function.
• Mild cases can recover with rest, some within a few weeks and without treatment.
• A splint works best as part of a package. On its own, a splint that holds the thumb and wrist tends to give temporary relief, with failure and recurrence often high, and a splint or cast alone ranked among the least effective options for pain in the medium term.
• Injection plus splint has the best support. The review recommends a steroid injection together with three to four weeks in a thumb splint as first-line treatment. The splint added a benefit that was statistically significant but too small to count as clinically important.
• Other treatments are unproven. Anti-inflammatory tablets are not supported by the existing studies, and there is no consensus or high-quality evidence for therapeutic ultrasound, laser or acupuncture. Shockwave with a splint ranked well for short-term pain, but the result came from a single study at high risk of bias, and the reviewers made no recommendation.
• Surgery is the last step. If symptoms persist three to four months after the first injection, the review advises an ultrasound scan to confirm the diagnosis and a second injection guided by ultrasound. Surgical release, which is highly effective, is recommended if that has not resolved it within another three to four months.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit.

• An injection of steroid beside the tendons. Most people improve after one, and no more than three are used. Very occasionally it thins the skin or changes its colour at the site.
• Surgery, which opens the roof of the tendon tunnel. Pain relief is usually rapid; temporary numbness on the back of the hand or thumb is possible.

How CARESPACE treats De Quervain’s

Physiotherapy

A physiotherapist can check which structure is sore, using the Finkelstein test and by examining the joint at the base of the thumb and the forearm tendons. From there the work is practical: which thumb splint to get and when to wear it, and which lifts, grips and pinches to change. For a new parent that can mean looking at how you pick up and hold the baby; for others it may be scissors, a hammer or a trowel. Once the pain has settled, gentle stretching and a gradual return to full use can follow. Trial evidence for exercise and hands-on treatment in De Quervain’s is limited, so the plan leans on resting the thumb, and on a physician’s injection if that is not enough.

See our physiotherapy team →

Other services people ask about

Acupuncture ranked second for short-term function in the review, but there is no consensus or high-quality evidence for it. Chiropractic care and massage therapy do not appear in the De Quervain’s research used here, which is why they have no section on this page.

Where most people start

Start with Physiotherapy. If the pain began with a fall onto the hand, see a physician or nurse practitioner first, because a broken scaphoid bone is one of the conditions that has to be told apart from it.

How your team works together

Non-surgical care for De Quervain’s usually needs only one service, physiotherapy. The other half is medical: if rest, a splint and activity changes have not settled it, your physician or nurse practitioner can arrange the injection.

Browse by service: physiotherapists.

What to expect at your first visit

1. How it started. A new baby, a new job or hobby, a fall, and which thumb movements hurt.
2. Thumb and wrist tests, including the Finkelstein test and a check of the thumb-base joint.
3. What the examination points to: De Quervain’s, or something a physician should see first.
4. First treatment, then a plan covering which movements to change and when to check progress.

What you can do at home

• Rest the thumb when you can, and stop or cut down the activity that brings the pain on.
• Wear a splint that supports the thumb and wrist, especially at night. Sports shops sell them.
• Ice can help: a wrapped ice pack on the sore side of the wrist for no more than 20 minutes, repeated every 2 to 3 hours.
• Do not lift heavy objects or grip anything too tightly.

NHS advice in the UK is to see a GP when two weeks of treating thumb pain yourself has not improved it.

How long De Quervain’s lasts

De Quervain’s can clear up by itself, and the prognosis is usually good. With home care, symptoms often improve within a few weeks. In parents of newborns it typically resolves once the baby needs lifting less often.

De Quervain’s treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

I have a newborn and cannot stop lifting. What can I do?

You cannot avoid lifting your baby, so the aim is to spare the thumb wherever there is a choice: avoid the painful movements when there is another way to do the task, wear a thumb splint, and have a physiotherapist look at how you lift and hold. The sources used here do not give a specific lifting technique.

Do I need a splint, and for how long?

A splint that holds both the thumb and the wrist is worth using, especially at night. In the trials, people wore one for three to four weeks after a steroid injection.

Should I get a cortisone injection?

It is the best-supported treatment, ideally with a splint. Whether and when is a decision to make with your physician or nurse practitioner.

Does physiotherapy help De Quervain’s?

It helps with the parts that depend on you: changing the movements that strain the thumb, choosing and using a splint, and returning to full use once the pain settles. It is not a substitute for an injection when rest and splinting have not been enough.

Where can I get De Quervain’s treated in Cambridge?

Physiotherapy, the main service for this condition, is one of the CARESPACE services in Cambridge, where the location is on Hespeler Road. Injections are arranged through your physician or nurse practitioner.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Challoumas D, Ramasubbu R, Rooney E, Seymour-Jackson E, Putti A, Millar NL. Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis. JAMA Network Open, 2023.
• Satteson E, Tannan SC. De Quervain Tenosynovitis. StatPearls, updated 2023.
• British Society for Surgery of the Hand. De Quervain’s syndrome. Patient information; no date is shown.
• HealthLink BC. De Quervain’s Tenosynovitis. Current as of 2022.
• NHS. Thumb pain, Wrist pain and Finger pain. Reviewed 2025.

Related conditions

Carpal Tunnel Syndrome
Trigger Finger

Ready to book?

Book online with a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking