1. Introduction / Plain Theory

De Quervain’s tenosynovitis is a condition involving irritation or thickening of the tendon sheath around the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons, located on the thumb side of the wrist.

These tendons pass through a narrow fibro-osseous tunnel at the first dorsal compartment.
Repetitive thumb motion or sustained gripping increases friction and pressure, leading to inflammation, pain, and impaired tendon glide.

It is particularly common in:

• New parents who frequently lift their infants (“mother’s wrist”).

• Office workers and smartphone users (“texting thumb”).

• Manual labourers, musicians, and athletes using repetitive thumb movements.

The condition is more prevalent in women aged 30–50 years and in individuals with hormonal or fluid-retention changes (e.g. during pregnancy or postpartum).

2. Typical Symptoms and Functional Impact

• Pain and tenderness on the radial (thumb) side of the wrist.

• Pain aggravated by gripping, lifting, or rotating the wrist.

• Swelling or palpable thickening over the tendons near the base of the thumb.

• A “creaking” sensation with movement in some cases.

• Positive Finkelstein’s test – sharp pain when the thumb is flexed into the palm and the wrist is ulnarly deviated.

Functional impact:
De Quervain’s tenosynovitis can make everyday tasks such as lifting a child, typing, cooking, or texting painful and fatiguing.
If untreated, it may lead to chronic thickening and restricted thumb motion.

Red flags:
Sudden severe swelling, bruising, or loss of thumb motion after trauma should be evaluated for fracture or tendon rupture.

3. Contributing Factors / Underlying Causes

• Repetitive thumb abduction and extension (e.g. texting, lifting, gripping).

• Poor wrist and thumb ergonomics during work or childcare.

• Hormonal and fluid-retention changes in pregnancy/postpartum periods.

• Direct trauma or scarring in the first dorsal compartment.

• Postural and shoulder dysfunction altering wrist and hand loading.

• Myofascial tension through the forearm and upper limb affecting tendon glide.

From an osteopathic perspective, local tendon irritation is often maintained by proximal dysfunctions — restricted shoulder or cervical motion, first-rib elevation, and altered neural or vascular supply — which increase distal strain and reduce recovery capacity.

4. Osteopathic Approach

Osteopathic treatment aims to reduce local irritation, restore mechanical balance, and improve circulation throughout the upper limb.

An osteopathic assessment may include:

• Palpation and assessment of wrist, thumb, and forearm mobility.

• Gentle mobilisation of the radiocarpal and carpometacarpal joints.

• Myofascial release to reduce tension in the forearm extensors and flexors.

• Mobilisation of the elbow, shoulder, and first rib to normalise kinetic-chain load.

• Indirect or functional techniques to decrease pain sensitivity.

• Advice on ergonomic modification (lifting technique, wrist support, posture).

• Guidance on gradual, pain-free reloading and self-care between sessions.

The focus is to restore tissue glide and functional integration rather than only treating local inflammation.

5. Scientific Evidence & References

Evidence supports manual therapy, splinting, and activity modification as first-line treatments for De Quervain’s tenosynovitis.
Recent studies show that addressing proximal biomechanics and combining soft-tissue mobilisation with education improves outcomes and reduces recurrence.

Osteopathic and physiotherapy-based approaches that integrate wrist, forearm, and shoulder mechanics align with best-practice conservative management.

References

1. Wolf JM, Sturdivant RX, Owens BD. Incidence of De Quervain’s tenosynovitis in a young, active population. J Hand Surg Am. 2009;34(1):112–115. Link

2. Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990;15(1):83–87. Link

3. Lane LB, Bost FJ, Hallett JP. Conservative management of De Quervain’s tenosynovitis: outcome with splinting and therapy. J Hand Surg Am. 2001;26(2):258–262. Link

4. Ilyas AM, Astifidis RP. De Quervain’s tenosynovitis: a review of the rehabilitation strategies. J Hand Ther. 2019;32(3):291–299. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for wrist and hand pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Titchener AG, White JE, Hin TJ, et al. Elbow and wrist overuse syndromes: diagnosis and management. BMJ. 2020;371:m4765. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for wrist tendinopathies: network meta-analysis. Front Pain Res. 2024;15:1507433. Link