De Quervain’s tendinopathy: understanding your wrist pain and getting back to activity

What is De Quervain’s tendinopathy?

Anatomy of the first compartment tendons

De Quervain’s tendinopathy affects the abductor pollicis longus and extensor pollicis brevis tendons, which run together through a narrow tunnel on the outer edge of the wrist, on the thumb side.[1] These tendons allow the thumb to spread and extend, a movement that’s extremely common in everyday life as well as in sport.

Why does this area become painful?

Pain appears when these tendons undergo repeated friction in their narrow tunnel, particularly during repeated movements combining thumb abduction and wrist tilting. Repeated gripping motions, racquet movements, or certain intensive manual activities contribute to this tendinopathy.

Symptoms and diagnosis of De Quervain’s tendinopathy

Typical pain and its triggers

The pain is located on the outer edge of the wrist, just above the thumb, triggered by spreading the thumb, gripping objects or tilting the wrist toward the little finger. Slight swelling along the tendon tunnel is sometimes visible, and Finkelstein’s test (folding the thumb into the palm, then tilting the wrist) typically reproduces the pain.

Differential diagnosis

Several types of wrist and thumb pain can look like De Quervain’s tendinopathy:

• Thumb joint conditions, with pain more centred on the joint at the base of the thumb
• Wrist joint conditions, with more diffuse pain and sometimes morning stiffness
• Carpal tunnel syndrome, with tingling in the fingers rather than purely mechanical pain

Causes and risk factors

De Quervain’s tendinopathy develops from repeated friction of the thumb tendons within their narrow tunnel.

Biomechanical and personal factors

• Repeated movements combining thumb abduction and wrist tilting
• Resuming or suddenly increasing a manual or sporting activity
• Repeatedly carrying a child (thumb spread, wrist tilted)
• Stiffness or a lack of strength in the wrist and forearm

Which sports contribute to De Quervain’s tendinopathy?

Any sport with repeated gripping and thumb movements exposes these tendons:

• Golf
• Racquet sports (tennis, badminton)
• Climbing
• Skiing (poles)
• Canoeing, kayaking and rowing
• Sports with repeated gripping of a handle or racquet

Treating De Quervain’s tendinopathy in rehab with a sports physio

The goal of treatment is to reduce friction of the tendons in their tunnel while progressively strengthening their capacity to absorb load.

1. 1Reducing pain and managing load
2. 2Wrist and finger mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Full forearm work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Progressive strengthening, the cornerstone of treatment

Progressive strengthening of the thumb tendons, combined with comprehensive wrist and forearm work, restores their capacity to absorb the load specific to your sport or activity.

In brief

• Progressive strengthening of the thumb tendons
• Comprehensive wrist and forearm work
• Correcting technique if needed
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt the movements that clearly reproduce the pain, while starting progressive strengthening as soon as possible.

When should you see a specialist for De Quervain’s tendinopathy?

If the pain persists for more than four to six weeks despite adapting your activities and following a well-run strengthening programme, a medical opinion is recommended to consider additional treatment options.

Expected recovery timeline for De Quervain’s tendinopathy

With a well-run strengthening programme, clear improvement is usually seen within a few weeks, with a full return to activities after several weeks of progressive strengthening.

Preventing recurrence

Once the pain has settled, a few measures help stop it coming back:

• Keep up regular strengthening of the thumb and wrist tendons
• Increase volume gradually when resuming intensive manual or sporting activity
• Vary your grips and movements during repetitive activities (carrying, racquet, handle)
• Correct your technique if a sporting movement puts excessive strain on the thumb

The HOPP care programmes to treat your De Quervain’s tendinopathy and get back to sport

This tendinopathy requires progressive, well-dosed strengthening. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your wrist is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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