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De Quervain Tendinitis: What It Is, Symptoms and Physical Therapy Treatment

Published on 2026-04-30 · PT Jefferson Ramírez

If you feel intense pain on the side of your wrist, near the thumb, that gets worse when you lift objects, "pinch" with your fingers or use your phone, you may be dealing with De Quervain tendinitis (also called De Quervain tenosynovitis).

In this guide I explain what this condition is, why it appears, how it is diagnosed and, most importantly, how it is treated conservatively with physical therapy, kinesiotherapy, electrotherapy and iontophoresis, based on the best available evidence.

What is De Quervain tendinitis?

De Quervain tendinitis is an inflammation of the tendons of the first extensor compartment, which are compressed under a sheath on the side of the wrist. These tendons are:

• Abductor pollicis longus (APL)
• Extensor pollicis brevis (EPB)

When these tendons become inflamed or irritated, the sheath thickens and thumb movement becomes painful, limiting everyday activities such as opening jars, carrying bags, writing or using your phone.

Why does it happen?

De Quervain tendinitis is usually an overuse injury, caused by:

• Repetitive wrist and thumb movements.
• Prolonged use of the phone or the mouse.
• Loads carried with the thumb in abduction (for example, carrying a baby).
• Repeated strong gripping and pinching motions.

It can appear in people of any age, but it is more common in women and in people who perform intense or prolonged manual activities.

Typical symptoms

Among the most common symptoms are:

• Pain on the side of the wrist and thumb.
• Pain that increases when you move the thumb or wrist.
• Pain when lifting objects or "pinching" with your fingers.
• A sensation of "cracking" or clicking when moving the thumb.
• Pain during the Finkelstein test (bending the thumb toward the palm and deviating the wrist to the opposite side).

If you recognize these symptoms, it is important not to ignore them, because the inflammation can become chronic and limit your daily life more and more.

Diagnosis

The diagnosis is made mainly on clinical grounds:

• Physical examination of the wrist and thumb.
• Finkelstein test.
• Assessment of strength and mobility.
• In some cases, it can be complemented with ultrasound to confirm the tendon inflammation and rule out other problems.

Imaging is not always needed, but ultrasound helps guide treatment and rule out associated injuries.

Conservative treatment with physical therapy

Current evidence shows that most cases of De Quervain tendinitis improve with conservative management, without the need for surgery. The most effective combination includes:

• Immobilization with a "thumb spica" splint.
• Education and load modification.
• Progressive kinesiotherapy.
• In some cases, a corticosteroid injection (performed by a physician) along with immobilization.

Physical therapy plays a key role in:

• Reducing pain and inflammation.
• Protecting the tendon while it recovers.
• Restoring mobility and strength without overloading the area.

Immobilization with a thumb spica splint

The thumb spica splint supports the wrist and the first metacarpal, keeping the thumb in a stable and protected position.

• It is generally worn almost continuously for 3 to 4 weeks.
• It is removed only for hygiene and controlled gentle mobility.
• It allows the tendons to calm down and reduces mechanical irritation.

Immobilization is one of the cornerstones of effective conservative treatment, especially in the acute phase.

Education and load modification

Education is key so that your tendon does not keep getting irritated:

• Temporarily avoid activities that increase pain:
  
  • Strong gripping.
  • Sustained pinching.
  • Excessive phone use with the thumb.
  • Lifting objects with the thumb in abduction.
• Distribute the load between both hands.
• Take frequent breaks and use ergonomic adaptations (mouse, keyboard, working posture).

The idea is to give the tendon time to recover, while introducing changes so the problem does not come back.

Kinesiotherapy (mobility and exercises)

Kinesiotherapy starts gently to avoid irritating the area further:

• In the acute phase, gentle and pain free mobility of the wrist and thumb.
• As the pain decreases, progressive strengthening exercises are added.
• The goal is to recover functional strength without increasing inflammation.

The specific evidence for exercise in De Quervain is more limited, but clinical consensus indicates that progression must be controlled and guided, always respecting the patient's tolerance.

Electrotherapy and TENS

Electrotherapy, such as TENS, can be used as a complementary tool to control pain:

• It works by stimulating nerve fibers to reduce the perception of pain.
• It does not cure the inflammation, but it helps you tolerate therapy and mobilization better.
• It is applied in short sessions and under professional supervision.

Direct evidence in De Quervain is limited, so electrotherapy is considered analgesic support, not the main treatment.

Iontophoresis

Iontophoresis consists of delivering an anti inflammatory medication (for example, diclofenac) through a gentle electric current over the affected area.

• It allows the drug to be delivered locally without the need for an injection.
• It can be useful as an option when an injection is not wanted or not possible.

In your treatment, it can be used as part of a comprehensive plan, together with immobilization, education and exercises.

When is surgery considered?

Surgery is reserved for cases where conservative treatment does not achieve results after a reasonable period of time (generally several months) or when pain and limitation are very severe.

The procedure consists of releasing the tunnel of the first compartment so that the tendons move with less friction.

However, most patients improve with conservative management, so surgery is not the first option.

What can you do starting today?

If you suspect you have De Quervain tendinitis:

1. Temporarily avoid the activities that increase your pain.
2. Use a splint or immobilization as recommended by a professional.
3. See a physical therapist to assess your case and design a personalized treatment plan.
4. Do not inject yourself or use strong medication without medical supervision.

The key is to act in time, before the inflammation becomes chronic and harder to treat.

Treatment at my physical therapy practice

At my physical therapy practice in Bogotá, I treat De Quervain tendinitis with a comprehensive, evidence based approach, which includes:

• Detailed clinical assessment.
• Use of a thumb spica splint and education on load modification.
• Progressive kinesiotherapy adapted to your tolerance and your daily life.
• Use of analgesic electrotherapy (TENS) when the pain calls for it.
• The option of iontophoresis as a complement to reduce local inflammation.

If you can no longer bear the pain in your wrist and thumb, and you notice that it is hard to open jars, carry your baby or work with your phone, do not wait any longer: you can book your assessment and start your personalized conservative treatment.

Ready to get your wrist and thumb back?

De Quervain tendinitis does not have to limit you forever. With the right treatment, most people recover function and return to their activities without pain.

If you would like me to prepare a personalized plan for your case, with session frequency, exercises and specific recommendations for your daily routine, write to me and we will arrange your assessment.