De Quervain's Tenosynovitis: Therapy Treatment

If you are considering occupational or physical therapy as a treatment for De Quervain’s Tenosynovitis treatment, we want you to be as informed as possible—so we can truly partner to create the best course of treatment for YOU.

In occupational therapy and physical therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them.

Members of the OT Potential Club can login for detailed clinical decision support on this diagnosis, including a comprehensive assessment search, goal bank, treatment info, handouts, a community forum and more.

Please note that this page is for educational purposes and does not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you in your De Quervain’s Tenosynovitis treatment.

A Quick Note on Why to Pursue Therapy First

This article focuses on therapy treatment for De Quervain’s Tenosynovitis. As with most conditions, conservative treatment like therapy is typically the first course of care. That is because therapy is safer and much more cost-effective compared to invasive options like surgery (which come with a host of risks and potential complications – not to mention long recovery times).

The number and frequency of therapy sessions needed to treat De Quervain’s Tenosynovitis conservatively will vary based on your initial evaluation. In general, the higher your initial disability score, the more frequent your sessions. Ultimately, our goal as therapists is to move you toward self-management to get you back to what you care about doing.

Therapist-Recommended Assessments for De Quervain’s Tenosynovitis

As you can see below, evaluating a case of De Quarvain’s Tenosynovitis involves much more than assessing the wrist itself. Because the nerves and muscles in your arm work together, areas like your thumb, forearm, or even elbow can play a role, even if the pain feels localized to one spot. A thorough exam helps your therapist see the whole picture, and make sure no other underlying issues are contributing to your discomfort.

Assessments also serve as a point of comparison to track your progress and response to treatment. (Without an accurate and thorough baseline, it can be hard to discern how much the interventions are helping!) Your therapist may perform certain assessments at various intervals over the course of therapy.

Core Occupational Therapy Outcome Measures

Here are two metrics that many OTs collect with every patient. Our most-used assessment measures your quality of life. At the end of the day, this is the most important outcome for us. We want our treatments to have a significant impact on your day-to-day life.

Quality of Life Patient Reported Outcome Measure: The PROMIS Global 10
Grip Strength

Patient Rated Outcome Measures

Administered at evaluation, re-evaluation, and discharge.

Upper Quarter Screen

Observation of Posture
Dermatomes, Myotomes, and Reflexes

Range of Motion (ROM) Assessment

Cervical ROM³
Shoulder ROM
Elbow ROM
Forearm ROM
Wrist ROM
Thumb ROM¹¹

Strength Testing

Grip strength bilaterally^5,11
Pinch strength including tip-to-tip, palmer, and lateral pinch¹¹
Manual Muscle Testing (MMT)
- Thumb¹¹
- Thenar eminence muscles
- Wrist Flex/Extend
- Elbow Flex/Extend
- Shoulder Flex/Abduct/ER/IR

Special Testing

De Quervain’s Tenosynovitis impacts women 3 times more than men, and is often associated with hormonal changes.¹⁷ Additional risk factors include age (peak incidence at 40-59 y.o), diabetes, rheumatoid arthritis, lupus, and hypothyroidism.¹⁸

Finkelstein’s Test ⁶
Brunelli’s test^14,16
WHAT test (wrist hyperflexion and abduction of the thumb) ¹⁵
Eichhoff’s Test¹⁵
“Wet Leather Sign” → crepitus with motion of the involved tendons
Triggering of the involved tendons
- Of note: Individuals with an extra compartment for the Extensor Pollicis Brevis are at higher risk for this
Dexterity Testing
- Purdue Pegboard Test

Setting Goals for De Quervain’s Tenosynovitis Therapy

Therapy only works when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you.

Goals may focus on areas such as activities of daily living, improving grip strength, and pain and fatigue management, among others.

Therapy Treatment Interventions for De Quervain’s Tenosynovitis

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program.

Aerobic Warm-up

Supports endorphin release for pain reduction and improved physical function.⁷

Orthosis

A custom forearm-based thumb spica orthosis may be recommended if there is acute onset and you are not receiving a corticosteroid injection. ¹⁹

Don’t fight your orthosis! If you resist it during a task, you risk further irritating your muscles instead of letting them rest and heal. If a specific activity causes a struggle, it’s best to either remove the brace for that task or avoid the activity altogether.

Manual Therapy

Instrument Assisted Soft Tissue Mobilization (IASTM)^8,9
Joint Mobilizations of CMC, Carpals, DRUJ
Decompression therapy (cupping)²²

Range of Motion Exercise

Flexibility of the thenar webspace
- I.e. Interlocking Thumb Stretch
Thumb IP and MP flexion/extension
Wrist ROM all planes
Forearm ROM all planes

Neuromuscular Re-education

Addresses coordination, proprioception, and motor planning. Proprioception refers to knowing where your body is in space.

Wrist strengthening and coordination²¹
Dynamic thumb stability
Postural stability
Core exercises
Shoulder strengthening
Advanced challenges: Coordination, proprioception, motor planning

Self Care Home Management and Activity Modification

Lifting mechanics
Ergonomic positioning and setup
Modification specific to new mothers for feeding and carrying

Patient Education on Disease Pathology

Incorporating Functional Tasks and Occupation-based Interventions Based on Patient Goals

Practice activity modifications for patient-identified I/ADLs in the clinic to promote carry-over at home

Pain Management Tools

Kinesiotape of thumb extensors
Modalities (heat, ice, ultrasound, iontophoresis, TENS)
Biofreeze
Salonpas topical patches

Discharge Suggestions

Every person is unique, so your individual response to therapy will also be unique. For some, it is not appropriate to continue therapy until the condition completely resolves. For others, pain may resolve before the entire rehabilitation program is established. In the latter case, it is important to remember that pain is a symptom—not a diagnosis—and that deficits in strength and endurance must be addressed to prevent recurrence. We also recommend that you:

Follow your therapist’s discharge recommendations to maintain progress made in therapy.
Continue to use self-management and empowerment strategies to control any remaining symptoms.
Follow a home exercise program with proximal posture component for an additional 3 months to help establish good body mechanic habits.
Consult your therapist if your condition worsens or if you continue to have difficulty with your daily activities after 3 months.

Choosing a Therapist for De Quervain’s Tenosynovitis

Both occupational therapists and physical therapists can treat De Quervain’s Tenosynovitis. In less severe cases, a generalist therapist from either discipline should be able to help.

It is important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They must also complete various recertification requirements every 5 years.

Below, you can find occupational therapy professionals who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.

Show as:List Map

Conclusion

Hopefully this article helped you understand what therapy for De Quervain’s Tenosynovitis entails – and whether you’re a good candidate for this type of treatment.

This article is updated regularly based on newly released research. If you have any research you would like us to consider, please drop it in the comments.

Therapists who would like more detailed information on De Quervain’s Tenosynovitis treatment best practices can join us as members of the OT Potential Club.

Therapists who would like more detailed information on De Quervain’s Tenosynovitis rehabilitation best practices can join us as members of the OT Potential Club.

Contributors

Rachel Egan, OTR/L, MS, CHT, COMT-UE
Sarah Lyon, OTR/L

References

Here’s the science that backs the assessment and treatment outlined above.

Shafiee E, MacDermid J, Farzad M, Karbalaei M. A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation. Disability and Rehabilitation. 2022.
Polson K, Reid D, McNair PJ, Larmer P. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther. 2010.
Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021.
Kuroiwa T, Nimura A, Suzuki S, Sasaki T, Okawa A, Fujita K. Measurement of thumb pronation and palmar abduction angles with a small motion sensor: a comparison with Kapandji scores. J Hand Surg Eur Vol. 2019.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985.
Dawson, C., & Mudgal, C. S. Staged description of the Finkelstein test. J Hand Surg 2010.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017
Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999.
Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997.
Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009.
Forget, N et al. Thumb Strength and Mobility in deQuervain’s Disease. J Hand Ther, 2006.
Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002
Louw, Adriaan & Zimney, Kory & Puentedura, Emilio & Diener, Ina. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 32. 1-24. 10.1080/09593985.2016.1194646.
Anderson SE, Steinbach LS, De Monaco D, et al. “Baby Wrist”: MRI of an overuse syndrome in mothers. AJR Am J Roentgenol. 2004
Goubau, JF, Goubau, L, Van Tongel, A, Van Hoonacker, P, Kerckhove, D, & Berghs, B.. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. The Journal of hand surgery, European 2014.
Brunelli G. Le test de Finkelstein contre le test de Brunelli dans la tenosynovite de De Quervain [Finkelstein’s versus Brunelli’s test in De Quervain tenosynovitis]. Chir Main. 2003
Neder Filho AT, Costa ACD, Barros RSM, Nakachima LR, Souza SCA, Rodrigues MP, Oliveira RK, Gama SAMD. The woman’s hand. Rev Assoc Med Bras (1992). 2023
Hassan K, Sohn A, Shi L, Lee M, Wolf JM. De Quervain Tenosynovitis: An Evaluation of the Epidemiology and Utility of Multiple Injections Using a National Database. J Hand Surg Am. 2022
Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I. Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial. Hand (N Y). 2020
Goodman CC. Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms. Journal of Hand Therapy. 2010.
Papa JA. Conservative management of De Quervain’s stenosing tenosynovitis: a case report. J Can Chiropr Assoc. 2012
Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. 2016 Jan;20(1):173-178. doi: 10.1016/j.jbmt.2015.11.009. Epub 2015 Dec 1. PMID: 26891653.

OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.