Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
De Quervain's tenosynovitis is one of the most common causes of thumb and wrist pain — and one of the most frustrating for new parents who develop it from picking up their baby. Physiotherapy with splinting and progressive loading resolves most cases without surgery.
What's Happening in the Tendon
Two tendons — abductor pollicis longus (APL) and extensor pollicis brevis (EPB) — travel from the forearm to the thumb through a narrow fibrous tunnel at the base of the thumb called the first dorsal extensor compartment. When these tendons are repeatedly stressed, the tendon sheath becomes inflamed and thickened, increasing friction and causing the characteristic pain with gripping and thumb movement.
Physiotherapy Treatment
Treatment for De Quervain's follows a progressive approach:
- Splinting: A thumb spica splint immobilises the thumb and wrist to offload the irritated tendons. Worn consistently — particularly during sleep and aggravating activities — this is often the single most effective intervention in the acute phase.
- Activity modification: Identifying and modifying the specific activities that aggravate symptoms — different grip patterns, tools, carrying techniques.
- Manual therapy: Soft tissue mobilisation around the first extensor compartment.
- Progressive tendon loading: Once acute inflammation settles, graduated strengthening of APL and EPB to restore tendon resilience.
- Return to activity planning: Gradual reintroduction of the aggravating activities — including lifting babies with proper wrist positioning for new parents.
De Quervain's in New Parents
The dramatic hormone changes of pregnancy and breastfeeding are thought to increase tendon susceptibility. Combined with the repetitive lifting of a newborn (often with the wrist extended and thumb abducted), this creates ideal conditions for De Quervain's to develop. Technique modification — scooping the baby from below with palms up, elbows close to the body — significantly reduces tendon load and is a key part of management in new parents.
De Quervain's Treatment at Better Physiotherapy Bundoora
We regularly see De Quervain's in new parents, desk workers, and tradespeople. We fit thumb spica splints on-site and design progressive loading programs. Call (03) 9467 6900 or book online.
Frequently Asked Questions
What causes De Quervain's tenosynovitis?
The condition is caused by repetitive thumb and wrist movements that create friction within the first dorsal extensor compartment. It is particularly common in: new parents (from lifting babies with the wrist extended and thumb outstretched — known colloquially as "mummy's thumb"), desk workers with repetitive mouse or keyboard use, musicians, gardeners, and racquet sport players.
What is the Finkelstein test?
The Finkelstein test is the primary diagnostic test for De Quervain's. The patient makes a fist with the thumb tucked inside, then deviates the wrist toward the little finger side. A sharp pain over the radial (thumb-side) wrist is a positive test. A physiotherapist performs this along with other tests to confirm the diagnosis.
Does cortisone help De Quervain's?
Yes — corticosteroid injection into the first extensor compartment is effective for De Quervain's and may produce faster initial relief than physiotherapy alone. However, it does not address the underlying cause. The best outcomes come from combining injection (if needed) with splinting, activity modification, and progressive tendon loading under physiotherapy guidance.
Do I need surgery for De Quervain's?
Surgery (release of the first dorsal extensor compartment) is rarely needed — fewer than 10% of cases. It is considered when 2–3 cortisone injections and conservative physiotherapy have failed to resolve symptoms. When performed, surgery is highly effective with rapid recovery.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora