Thumb-sided Wrist pain? Here's an 8-Week Conservative Treatment Plan for De Quervain’s Tenosynovitis

Your Guide to Reducing Pain, Improving Mobility, and Getting Back to What You Love

De Quervain's tenosynovitis – it's a bit of a mouthful, isn't it? But if you're experiencing pain on the thumb side of your wrist, you're likely all too familiar with the impact this has on your basic daily tasks. As a Certified Hand Therapist who has dealt with this personally, I'm here to shed some light on this common issue and, more importantly, empower you with conservative strategies to find relief and get back to doing the things you love, pain-free!

De Quervain's, often called "Mommy Thumb" happens when the tendons on the thumb side of your wrist, which help you move your thumb outwards and upwards, become inflamed and irritated. Think of these tendons like ropes gliding through a tunnel. When the tunnel narrows or the ropes get frayed, movement becomes painful.  It can make everyday tasks — lifting a child, opening jars, pulling apart bags of food, typing, texting, and even dressing tasks such as hooking a bra or pulling up your pants — surprisingly painful. But here's the good news: for many, conservative (non-surgical) management is incredibly effective!

How do I know If I have De Quervain's?

1. Making a fist with your affected hand, tucking your thumb inside the fingers.

2. Gently bending your wrist toward your little finger (ulnar deviation).

A sharp, shooting pain along the thumb side of the wrist is considered a positive test result, indicating irritation and inflammation of the two tendons (the abductor pollicis longus and extensor pollicis brevis) that define De Quervain's tenosynovitis.

This test helps a Certified Hand Therapist (CHT) or physician confirm the diagnosis and start you on the right path toward conservative management!

8-Week Conservative Treatment Plan for De Quervain’s Tenosynovitis

At Ascend Therapy, I follow an evidence-informed, step-by-step approach that reduces tendon irritation, restores mobility, and gradually strengthens the wrist and thumb so you can return to normal function without surgery.

Below is an example of an 8-week conservative management plan commonly used to treat De Quervain’s effectively.

Weeks 0–2: Reduce Pain and Protect the Tendons

Goals:

• Calm irritation and inflammation

• Reduce friction on the affected tendons

• Maintain gentle mobility without aggravation

What This Phase Includes:

• Thumb-Spica Splint: Helps rest the inflamed tendons by limiting thumb and wrist movement. Worn full-time during the day or during painful activities. Only wear at night if you tend to sleep with your thumb tucked in your palm.

  • I personally have 3 different thumb spica splints that I alternated depending on the severity of my symptoms, but my favorite of the 3 would have to be my "middle ground" splint the Comfort Cool CMC Restriction Splint. You can find it easily online, but there are several excellent options available as well.

  

  Comfort Cool CMC Restriction Splint

• Activity Modification: Avoid heavy pinching activities with the painful thumb, repetitive gripping, frequent texting, wringing motions, or lifting infants under the arms. Try scooping with the hands and arms as opposed lifting with heavy pressure on the thumb.

• Pain Management: Ice for flare-ups; heat if the wrist feels stiff rather than swollen. NSAIDs may be used as directed by a provider.

• Gentle Mobility: Light wrist movements, thumb opposition (touching thumb to the tips of each finger), and gentle tendon-gliding such as thumb twiddling clockwise and counterclockwise — only in pain-free ranges.

Weeks 2–4: Restore Mobility and Controlled Motion

Goals:

• Improve thumb and wrist range of motion

• Begin controlled tendon movement

• Start weaning from the splint as tolerated

What This Phase Includes:

• Reduced Splint Use: Use mostly during high-demand tasks such as lifting, childcare, cooking, or work activities. This is where I might also transition from a bigger more restrictive splint to a softer or less restrictive splint.

• Stretching and Mobility: Gentle thumb stretches, wrist deviation (side to side motion) exercises, and soft tissue work along the first dorsal compartment (thumb side of the wrist).

• Tendon-Gliding Progression: Slow, controlled thumb and wrist movements to improve tendon mobility without increasing pain.

• Ergonomic Changes: Adjusting workstations, modifying lifting techniques, using larger grips, and changing repetitive tasks that strain the wrist.

  

  Unbuckleme Car Seat Buckle Release

  
  

Weeks 4–6: Gradual Strengthening and Load Tolerance

Goals:

• Build tendon strength

• Improve grip and stability

• Increase tolerance for daily activities

What This Phase Includes:

• Kinesiotaping: When weaning out of the splint, adding light support with kinesiotaping is an excellent way to managing residual pain symptoms while building strength and tolerance.

  Light Strengthening: Rubber-band thumb extensions, isometric wrist strengthening, light dumbbell radial deviation, and gentle pinch work with soft putty.

• Functional Re-Training: Practicing daily tasks with improved wrist posture — using the whole hand instead of pinching, avoiding heavy ulnar deviation (wrist bending towards the little finger), and lifting with a neutral wrist.

• Soft Tissue Work: Gentle cross-friction massage or forearm muscle treatment as tolerated.

Weeks 6–8: Return to Activity and Prevent Recurrence

Goals:

• Resume normal activity without pain

• Build long-term tendon resilience

• Prevent future flare-ups

What This Phase Includes:

• Moderate Strength Progression: Increased resistance for wrist and thumb exercises, eccentric strengthening, and more advanced grip training.

• Functional Simulation: Practicing the real-life tasks that originally caused pain — childcare, cooking, typing, gym activities, etc.

• Discontinuing the Splint: Once you can perform daily activities pain-free.

• Long-Term Prevention: Proper lifting mechanics, ergonomic tools, micro-breaks, and continued strengthening 2–3 times per week.

  

When to Consider an Injection

If symptoms remain moderate after 4–6 weeks of consistent conservative care, a corticosteroid injection may be recommended. Research shows that combining an injection with continuing therapy often leads to excellent outcomes.

Start Your Recovery with Ascend Therapy

If thumb and wrist pain are limiting your daily life, you don’t have to navigate it alone. At Ascend Therapy, I provide personalized assessment, hands-on treatment, and a tailored home program to help you relieve pain and confidently return to work, hobbies, and the activities you enjoy most.