How to Treat and Prevent De Quervain's Tenosynovitis | Precision Movement

How to Treat and Prevent De Quervain’s Tenosynovitis

Thumb Pain From Texting? Here’s What To Do…

By Eric Wong

Too much texting causing you thumb pain? Learn how to treat De Quervain’s tenosynovitis before the pain starts to inhibit more than just time on your phone.

Modern Pains

I found an interesting stat that showed that in 2016, almost 1.5 billion cell phones were sold.

That’s a staggering number and that’s just for one year.

It’s no wonder people are developing associated problems like forward head posture, neck pain and thumb pain from texting, aka De Quervain’s tenosynovitis.

de quervain's tenosynovitis forward head

Last year I had the beginnings of De Quervain’s as I was suddenly experiencing pain when using my phone and quickly connected it to typing on my phone with my thumbs as well as using the mouse.

I decreased my phone usage, switched to using my left thumb only to swipe when reading articles and moved my mouse over to the left hand.

These actions eliminated the root causes of my issue to allow the therapies to work. It’s critical that you identify what your root causes are, because the best treatments cannot work if you do not identify and eliminate the root causes.

Once you’ve done this, follow the 3 phases of treatment below to fix De Quervain’s and prevent it from returning.

To start, let’s learn a little bit more about what is actually going on anatomically to cause this pain.

Teno-syno-what-is?

First things first, it’s important to differentiate the tenosynovitis in De Quervain’s tenosynovitis from tendonitis – a term you might be more familiar with.

Both signify an issue with inflammation and your tendons, but with a crucial difference.

Tendonitis is inflammation of the tendon itself, while tenosynovitis is the inflammation of the sheath lining the tendon [1].

This particular form of tenosynovitis is named after the Swiss surgeon who first identified it, Fritz de Quervain [2]. (Back then, in 1895, the condition was associated with repetitive stress from washing clothes for a living, not texting!)

So when De Quervain’s is at play, the tissue affected is the protective lining covering the tendons connecting your thumb and wrist. Some very interesting anatomy in these tendons helps explain why tenosynovitis so commonly shows up in this region.

Anatomy of Texting Pain

There are two tendons in your thumb that are involved in this issue – your extensor pollicis brevis (EPB) and your abductor pollicis longus (APL).

These two tendons are located right next to each other and connect the base of your thumb to your wrist and forearm. Where the tendons pass the inside of your wrist, they share a single synovial sheath [3].

de quervain's tenosynovitis anatomyImage by www.mdguidelines.com

When working correctly, the tendons slide past one another freely to support easy movement of your thumb. But when the sheath becomes inflamed, movement of your EPB and APL becomes restricted and painful, and you’ve got De Quervain’s tenosynovitis on your hands (or thumbs, I guess).

What Causes De Quervain’s Tenosynovitis?

Today this condition is most often associated with texting and other smartphone use.

Whether you’re sending a ton of texts, shooting off of emails from your phone, or ripping through your Instagram feed, you might be putting excess strain on the region.

de quervain's tenosynovitis thumb pain

Two main factors cause and contribute to this – overuse and improper positioning [3] – i.e., bad posture of your hand and wrist.

That repetitive movement of the thumb as you text or do other repetitive motions (like maybe if your job or favorite hobby requires repetitive pinching or grabbing motions with the thumb) can cause inflammation.

Furthermore, if you are in wrist extension and ulnar deviation, which is common to angle the phone to look at it in front of you, it could contribute to the issue by creating a compression point that puts extra pressure on the thumb tendons [4].

Signs of De Quervain’s Tenosynovitis

Unfortunately, because of how crucial thumb movements are to so many things we do in our daily lives, you’re likely to notice symptoms showing up in a ton of your daily life activities if you’re dealing with De Quervain’s.

Common issues include:

Pain with rapid flexion or extension

In other words, those quick movements back and forth, forwards and backwards that you do with your thumb as you shoot it all over the place to fire off texts is going to trigger some pain.

The pain is often felt at the base of your thumb, or along this side of the wrist [5]. You may also feel like your thumb is catching.

Pain with radial deviation

Take a second and reach your arms out in front of you, palms facing down. Keeping your arms stable, start to move your thumbs toward each other, so that the thumbs are also moving closer to your forearms – this is radial deviation.

De Quervain’s is likely to cause pain when you make this movement – like when you go to twist open a jar of food in your kitchen.

de quervain's tenosynovitis pain

Decreased thumb range of motion in all directions

Your thumb ROM is likely to majorly suffer if you’re experiencing De Quervain’s synovitis. And this will show up in more than just that wrist radial deviation we just discussed.

Your thumb itself will likely to feel stiff and unable to move through its full complete range of motion in all directions. You may even see some swelling in the area that can contribute to reduced mobility [6].

You might notice this causing difficulty with your grip and manual dexterity.

Testing for Tenosynovitis

To help you determine whether or not De Quervain’s tenosynovitis is causing your pain, there is one simple test you can perform – the Finkelstein test [7].

To execute this test, simply make a fist with your hand – but make sure the rest of your fingers wrap AROUND your thumb, so it is inside your fist.

From here, start to bend at your wrist, moving the little finger side your first closer towards your forearm (this is ulnar deviation, the opposing motion to the radial deviation we discussed earlier).

how to diagnose de quervain's tenosynovitis

Image by doctorsgates.blogspot.com

If this ulnar deviation movement causes pain, you can bet you’re dealing with De Quervain’s tenosynovitis.

Steps to Rehab Thumb Pain from Texting

Once you’ve determined that the root issue is De Quervain’s, you can start to address the issue and move forward. I’ve broken the rehab process into 3 key stages.

Phase 1: Acute

In the first phase, your pain is acute and your symptoms are really getting in your way of accomplishing your daily activities. At this point, the key is to rest and manage inflammation so that the involved tissues get a chance to heal.

And yes, that means that you need to PUT THE PHONE DOWN. I’m serious, STEP AWAY FROM THE PHONE.

de quervain's tenosynovitis - thumb pain from texting

I know it’s hard, but you’ve got to cut back on the repetitive movements that got you here if you want to heal effectively.

Go back to basics and follow the RICE method – Rest, Ice, Compression, and Elevation. Make sure to apply ice and compression throughout the day as needed, but not for more than 15 minutes at a time.

You can also help encourage the healing process along by incorporating natural anti-inflammatories into your diet. Turmeric supplements like PuraThrive, omega-3 rich foods or supplements, and bone broths full of collagen are all great ways to help ease inflammation.

Phase 2: Post-Acute

Once your pain eases up a bit, it’s time to incorporate some gentle movements that will start to rebuild range of motion and continue to support healing.

Try a gentle stretch based off that diagnostic Finkelstein test. Just hold your first the end of that ulnar deviation for 30 seconds, repeating multiple times throughout the day.

It’s important to not over-stretch, so just stretch into mild and not intense discomfort, otherwise you risk further aggravating the area.

You should also start to use some self-massage in the area.

I find it helpful to massage both along the direction that the affected EPB and APL tendons run AND across them.  Aim for 2-3 minutes of massage 2-3 times a day.

Phase 3: Return to Sport/Work/Life

Now it’s time to start really amping things up so that you can improve your wrist strength and mobility to help keep the pain from reoccurring. I’ll give you 4 great exercises below that will do just that.

BUT… It’s important that this return to work and life doesn’t just mean falling back into old habits. Remember that overuse is the main contributor to thumb pain from texting.

So don’t just go back to texting mindlessly all day! Our phones are awesome tools, but be conscious of how often you’re using one and take it easy.

And hey, your thumb and wrist benefit won’t be the only parts of your body to benefit. Your neck and upper back are probably also going to be WAY better off if you limit time spent hunched over that little gadget.

de quervain's tenosynovitis and texting

With that said, let’s get into the 4 exercises.

Wrist Extension Drill

Training your wrist extensors is especially important for improving the overall health of your wrists because the opposing muscle group – the flexors – gets trained every time we grip onto anything. The extensors are often overlooked and undertrained, leading to muscular imbalances that leave you more prone to injury.
how to treat a sprained wrist - wrist extension

Watch Video: Click here to watch the Wrist Extension video

  • Straighten your arm at the elbow and bring your hand towards the wall, with your wrist extended fully and fingers straightened
  • Place your hand high on the wall and start to slide it down the wall, keeping the elbow straight
  • Try to maintain full wrist extension as you slide the hand down
  • When your hand gets to about shoulder level, maintain extension as you press weight into the wall to increase the force and stretch
  • Release the pressure to slide your hand back up the wall and repeat on the other arm

Wrist Extension Mobilization

This next technique is another one aimed at improving wrist extension. This move will help increase your wrist extension range of motion and overall wrist mobility.
how to treat a sprained wrist - Wrist Extension Mobilization

Watch Video: Click here to watch the Wrist Extension Mobilization video

  • Straighten your arm at the elbow and bring your hand towards the wall, with your wrist extended fully and fingers straightened
  • Place your hand high on the wall and start to slide it down the wall, keeping the elbow straight
  • Try to maintain full wrist extension as you slide the hand down
  • When your hand gets to about shoulder level, maintain extension as you press weight into the wall to increase the force and stretch
  • Release the pressure to slide your hand back up the wall and repeat on the other arm

Wrist Flexion Mobilization

You’ve got to stay balanced. This technique is the flexor mobilization partner to the technique above.

Use this mobilization to increase your wrist flexion range of motion and alignment, and to build a healthy and well-balanced wrist.
how to treat a sprained wrist - Wrist Flexion Mobilization

Watch Video: Click here to watch the Wrist Flexion Mobilization video

  • From a quadruped or kneeling position, place the top of your hand on the floor by your side – your fingers should be pointing back towards your feet
  • Spread your fingers, turn your elbow down, and straighten your arm to start
  • Begin to press your weight back until you feel a moderate stretch in your wrist
  • Release and press back (gently) for 10 reps

Wrist Flexion and Shoulder Rotation

If you’ve spent much time at all here at Precision Movement, you know that nothing is isolated when it comes to your body’s biomechanics. Injuries in the thumb and wrist can often travel up the arm and shoulder, causing excess tension as the muscles tighten in an effort to prevent other injuries.

Use this exercise to combat this. It provides a great stretch along the length of the arm, from your fingers to your shoulder joint.
how to treat a sprained wrist - Wrist Flexion and Shoulder Rotation

Watch Video: Click here to watch the Wrist Flexion & Shoulder Rotation video

  • Reach your arm straight out to the side
  • Flex your wrist (pointing fingers downward) before rotating from the shoulder (your fingers will start to point behind you)
  • Maintain a straight elbow
  • Repeat for 30 seconds to a minute before switching sides

Follow the 3 rehab steps above if you’re dealing with De Quervain’s tenosynovitis, moving on to the exercises when you’re ready.

If you’re more concerned about prevention, try to work these moves into your routine to build strength and balance in the region.

You’re all done reading now, so put the phone down for a bit and give them a go!

About the Author

Eric is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent many years focused on training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee for work and bitter IPAs for play.Click here to learn more about Eric.

>