De Quervain's Tenosynovitis

Written by Dr. Jason Ngan, DC

What is de Quervain's Tenosynovitis?

de Quervain's Tenosynovitis (aka radial styloid tenosynovitis, mommy’s thumb) is an overuse injury of the muscle tendons and synovium at the base of the thumb. It is named after Swiss surgeon Fritz de Quervain in 1895. The tendons affected are the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) located at the anatomical snuff box. These muscles abduct and extend the thumb. The snuff box is the deepened triangle at the back of the hand by the base of the thumb. The snuff box got its name from people using this area to sniff tobacco and cocaine.

What Causes de Quervain's Tenosynovitis?

Excessive abduction and extension of the thumb will develop into de Quervain’s tenosynovitis.

  • Repetitive motions such as writing and using the computer mouse

  • Lifting a baby repeatedly

  • Pregnancy will retain fluids

  • Muscle strain of the EBP or APL

  • Inflammatory arthritis such as rheumatoid arthritis can also irritate the tendons

What are the Signs and Symptoms?

  • Pain and tenderness at the snuff box

  • Swelling at the snuff box

  • Decreased range of motion of the thumb

  • Catching or snapping sensation when moving the thumb

How is de Quervain's Tenosynovitis Diagnosed?

De Quervain’s tenosynovitis is diagnosed with a medical history, physical examination, and orthopedic testing.

What are the Treatment Options?

The main treatment is to stop the repetitive motions that caused de Quervain’s. Some options that can speed up recovery include:

  • Chiropractic manipulation and mobilization

  • Soft tissue therapies

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Rest from activities

  • Splint or bracing the thumb and wrist

  • Ergonomic counseling

  • Rehabilitative exercises and stretches

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, epidural steroid injections, and surgery if severe.  

References

  1. Caruthers, Lindsey Brown MS, PA-C. De Quervain tenosynovitis. JAAPA 33(7):p 49-50, July 2020. | DOI: 10.1097/01.JAA.0000668844.44726.68

  2. Goel R, Abzug JM. de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015 Mar;10(1):1-5. doi: 10.1007/s11552-014-9649-3. PMID: 25762881; PMCID: PMC4349843.

  3. Howell ER. Conservative care of De Quervain's tenosynovitis/ tendinopathy in a warehouse worker and recreational cyclist: a case report. J Can Chiropr Assoc. 2012 Jun;56(2):121-7. PMID: 22675225; PMCID: PMC3364061.

  4. Papa JA. Conservative management of De Quervain's stenosing tenosynovitis: a case report. J Can Chiropr Assoc. 2012 Jun;56(2):112-20. PMID: 22675224; PMCID: PMC3364060.

  5. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/