De Quervain’s Tendinitis

What is De Quervain's Tendinitis?

De Quervain's tendinitis is a painful condition of the first dorsal compartment of the wrist, a tunnel on the thumb side that holds the tendons of the abductor pollicis longus and extensor pollicis brevis.^[1] Its more precise name is De Quervain's tenosynovitis, a narrowing (stenosis) of this tunnel that restricts how the tendons glide and causes pain over the radial styloid, the bony bump at the base of the thumb side of the wrist.^[2]

Common symptoms

The main symptom is pain on the thumb side of the wrist, which gets worse when you grip, pinch, lift or turn the hand.^{[1, 2]} Tenderness and swelling over the area are common, and the pain can limit everyday tasks such as work, sport or caring for a baby.^[2]

Causes and risk factors

The exact cause is still debated. Some researchers favor an inflammatory process and others favor degenerative change in the tendon sheath, and there is substantial evidence for both views.^[1] Repetitive movements of the thumb are linked to the condition, and anatomical differences in the tunnel may make some people more likely to develop it.^{[1, 3]}

A review of studies on smartphone use found that more frequent text messaging was associated with a higher rate of De Quervain's, although an association like this does not prove cause.^[3] In one large review of trials, about 80% of the participants were women.^[4]

How it is diagnosed and treated conventionally

The diagnosis is made mainly from your history and a physical examination, using tests such as Finkelstein's test. These tests are not very specific, and ultrasound can help, especially to find anatomical variations before an injection.^{[1, 2]}

Treatment is usually conservative first: rest from the aggravating activity, a thumb splint, anti-inflammatory medicine and corticosteroid injection, with surgery to open the compartment if these do not work.^{[5, 6]} A network meta-analysis of trials concluded that a corticosteroid injection followed by 3 to 4 weeks of thumb splinting should be considered first-line treatment.^[4] Another review reported that injection plus a splint appeared to work better than either one alone, although corticosteroid use is not harmless and should be done with caution.^[5] Surgical release gives excellent symptom relief in many people when conservative treatment fails.^[6]

Why De Quervain's Tendinitis calls for a whole-person approach

De Quervain's is not just a thumb problem. The way the hand is used, the tendon itself, the tunnel anatomy and the person's wider health all play a part, and researchers do not agree on a single cause.^[1]

Care that looks at these factors alongside splinting and medical treatment is a reasonable addition. It does not replace them.

Repetitive hand use

Repeated thumb movements are linked to the condition, and in one review the amount of texting, browsing and gaming on a phone was associated with higher odds of De Quervain's.^[3] Changing how you grip and use the hand is a standard part of hand therapy.^[7]

Tendon sheath inflammation and degeneration

Researchers have proposed both an inflammatory and a degenerative explanation for the thickened sheath, and the evidence supports both.^[1]

Anatomy of the compartment

Structural differences from the usual anatomy are partly linked to who develops the condition, and a divider inside the tunnel matters for treatment planning.^{[1, 2]} That is why ultrasound is sometimes used before an injection.^[5]

Muscle tension in the forearm and hand

Tendon problems often go along with problems in the muscles that move them, and one acupuncture author has proposed needling the affected forearm and thumb muscles as well as the painful spot. This is a proposal in a short opinion paper, not tested evidence.^[8]

Acupuncture for De Quervain's Tendinitis

What the research shows

The evidence for acupuncture in De Quervain's is limited, with one small trial and mixed results in reviews. In a trial of 30 patients, five 30-minute acupuncture sessions were compared with a single methylprednisolone injection. Both groups improved in pain and function over 6 weeks, and the injection group did somewhat better.^[9] The trial had no sham or no-treatment group.

Two network meta-analyses reached different conclusions. One of 21 studies (1,178 adults) ranked acupuncture third, after splint plus injection and injection alone, with all active treatments outperforming waitlist controls. The authors rated the certainty of the evidence as low to very low and most studies as high risk of bias.^[10] The other, of 14 randomized trials, found that acupuncture, like injection alone, platelet-rich plasma and a splint alone, did not differ significantly from placebo for short-term pain.^[11]

A review of treatments for De Quervain's and similar hand tendon conditions concluded that more high-quality trials are still needed.^[12]

How acupuncture may work

How acupuncture might help De Quervain's has not been shown. The trial above measured pain and function only.^[9] In traditional Chinese medicine, wrist pain like this is described as blocked qi and blood in the channels along the thumb side of the forearm, and points along the lung and large intestine channels are often used. This is a traditional framework, not a proven mechanism.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the forearm, hand and wrist, and sometimes elsewhere in the body, usually left in place for about 20 to 40 minutes. The trial gave five sessions of 30 minutes, using points on the arm and tender spots.^[9] We plan a short course of visits and reassess whether it is helping.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Redness, warmth and fever at the wrist need medical assessment first.

Ayurvedic medicine for De Quervain's Tendinitis

The Ayurvedic view

Ayurveda has no classical name that matches De Quervain's. In this tradition, tendon and joint pain with stiffness and pain on movement is described as a Vata imbalance, sometimes with swelling linked to Kapha or heat linked to Pitta. These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to calm Vata, such as warm, regular meals and steady sleep
• Warm medicated oil massage of the forearm and hand, and gentle local heat
• Herbs traditionally used for pain and swelling, such as turmeric, ginger and Boswellia, which need review if you take blood thinners^[14]
• Rest from aggravating hand movements, alongside any splint your clinician recommends^[5]

Panchakarma, the traditional cleansing program, is not directed at a single tendon sheath and is not appropriate during pregnancy, acute illness or frailty.

What the research shows

There is no clinical research on Ayurveda for De Quervain's tendinitis. A PubMed search found no trials of Ayurvedic treatment, oil therapy or Ayurvedic herbs in this condition. The therapies above are traditional practice, and we cannot point to evidence that they relieve De Quervain's pain.

Herbal medicine for De Quervain's Tendinitis

Herbs and formulas that have been studied

No herbal formula has been tested in a clinical trial for De Quervain's tendinitis, as far as we could find. Chinese herbal medicine is traditionally used for tendon and joint pain, often taken by mouth or applied to the skin as a wash, plaster or liniment. Herbal preparations applied to the skin fall under the clinic's transdermal medication therapy.

What the research shows

The evidence is absent. We found no randomized trials, systematic reviews or controlled studies of herbs, Chinese formulas or Ayurvedic herbs for De Quervain's tendinitis. We therefore cannot say whether herbs help, and no herb should be taken in place of splinting, injection or surgery.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious problems such as bleeding and hematomas when warfarin was combined with herbs including dan shen (Salvia miltiorrhiza), dang gui (Angelica sinensis), ginger and Boswellia.^[14] A broader review found that herb-drug interactions can have serious clinical consequences, so people taking blood thinners, aspirin or other prescription drugs need a practitioner's review first.^[15]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned. Skin preparations should not be used on broken or inflamed skin.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes De Quervain's as obstruction of qi and blood in the channels of the thumb side of the forearm. Biomedicine describes a thickened sheath around two tendons in a narrow tunnel, with debate over whether inflammation or degeneration drives it.^{[1, 2]}

Ayurveda's description of aggravated Vata with pain on movement covers a similar picture in different words. No study has shown that a dosha or a qi pattern corresponds to a specific biological process in the wrist.

How this care fits with your medical care

Integrative care for De Quervain's tendinitis is complementary. Keep your physician, hand specialist or hand therapist, and continue the splinting, injection plan or surgery they recommend, because these are the best-supported treatments.^{[4, 12]} Do not stop or change prescribed medicines without your prescriber.

We do not diagnose the cause of wrist pain, so new thumb-side wrist pain should be medically evaluated first. Please bring your diagnosis, any ultrasound reports, a full list of medicines and supplements, and details of past or planned injections or surgery.

When to seek urgent medical care

Some causes of wrist and hand pain need prompt medical assessment.

• Redness, warmth, swelling and fever in the wrist or hand, which can mean infection
• Numbness or tingling that spreads in the hand, or loss of grip strength
• Severe pain after a fall or injury, or a deformed wrist
• A hand that turns pale, cold or blue
• Pain that is getting steadily worse despite treatment

If any of these occur with severe symptoms, call 911 or go to the nearest emergency department.