Houston Methodist. Leading Medicine

Hand FAQ


I am a stay-at-home Mom with two small children. Whenever I lift one of the kids from under the arms, I get a sharp, stabbing pain in my wrist right at the base of the thumb. I'm having more and more trouble opening jars and even turning doorknobs. I'm only 33 years old. Could I possibly have arthritis already?


The differential diagnosis of wrist/thumb pain includes several possibilities. The only way to find out for sure is to see your doctor for an evaluation. He or she will take your history, look at your signs and symptoms, and perform some tests to identify the specific underlying problem. It could be early arthritis but it's more likely to be something like tendinitis, tendinosis, or de quervain's tenosynovitis. Tendinitis is an inflammation of the tendon sheath (lining or covering) causing local swelling and pain. Tendinosis refers to the fact that there's no active inflammation present. Instead, cells taken from the tendons and tendon sheath show that the collagen fibers making up the tendons and tenosynovium are laid down in a haphazard fashion (every which way). The tenosynovium is a slippery covering that allows the tendons to glide easily back and forth as they move the thumb. Changes in the mucous cause these normally slippery structures to dry out. The tendons can no longer slide and glide smoothly. The dryness causes a painful catching of the tendon over the bone. de Quervain's tenosynovitis is a fairly common cause of wrist and thumb pain that occurs with motions just like you are describing. This condition affects two thumb tendons: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole. This tunnel is lined with tenosynovium, which allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon called tenosynovitis constricts the movement of the tendons within the tunnel. The treatment for each of these conditions is slightly different but usually involves rest, activity modification, and in the case of true inflammation, an antiinflammatory medication. In more severe cases, a local steroid injection into and underneath the tendon sheath can help reduce pain enough to keep moving. Surgery may be needed, but this is not usually considered until a course of three to six months of conservative care has been tried first. Asif M. Ilyas, MD. Nonsurgical Treatment for de Quervain's Tenosynovitis. In The Journal of Hand Surgery. May/June 2009. Vol. 34A. No. 5. Pp. 928-929.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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