De Quervain's tenosynovitis is a painful condition of the tendons on the thumb side of the wrist, which makes lifting, gripping and turning the hand surprisingly difficult. It is particularly common in new mums, hence its familiar name, “mummy’s thumb”, but it also affects gardeners, craftspeople, office workers and anyone whose hands work hard. At our Harley Street practice in London, Ms Anna De Leo, a GMC-registered Consultant Plastic Surgeon with the European Diploma in Hand Surgery and specialist microsurgical training, provides careful diagnosis and a stepwise treatment plan.
Most patients improve without an operation, through splinting, activity advice and, where appropriate, a targeted steroid injection. For the minority whose pain persists, a short surgical release under local anaesthetic, taking around ten to fifteen minutes, reliably frees the affected tendons and restores comfortable use of the hand.
01What Is De Quervain's Tenosynovitis?
Two tendons, abductor pollicis longus and extensor pollicis brevis, run along the thumb side of the wrist to move the thumb away from the hand and straighten it. On their way, they pass through a snug tunnel known as the first dorsal compartment, roofed by a band of fibrous tissue. When the lining of this tunnel becomes inflamed and thickened, the tendons can no longer glide smoothly, and every movement of the thumb or wrist becomes painful.
Typical symptoms of De Quervain's tenosynovitis include:
- Sharp, often intense pain over the thumb side of the wrist, sometimes spreading up the forearm.
- Localised swelling or a tender thickening at the base of the thumb.
- Pain when lifting a baby, pouring a kettle, wringing a cloth or turning a key.
- Occasionally a creaking or catching sensation as the thumb moves.
The condition, also called De Quervain's tendinitis, is most often linked to repetitive lifting and gripping with the thumb outstretched. New mothers are especially prone in the months after birth: hormonal changes during pregnancy and breastfeeding combine with the constant lifting and supporting of a baby’s head, which places the thumb in exactly the position that strains these tendons. Manual work, gardening, carpentry, racquet sports and prolonged smartphone use can all contribute, as can inflammatory arthritis.
02Diagnosing De Quervain's Tenosynovitis and Non-Surgical Treatment
Diagnosis is mainly clinical. Ms Anna De Leo will examine the wrist for tenderness and swelling over the first dorsal compartment and perform specific tests, such as gently folding the thumb into the palm and tilting the wrist towards the little finger, which typically reproduces the pain. She will also exclude conditions that can mimic De Quervain's tenosynovitis, including arthritis at the base of the thumb, a ganglion cyst, a scaphoid problem or irritation of the small sensory nerve on the back of the wrist. Ultrasound or X-rays are used when the diagnosis needs confirming.
Non-surgical treatment is effective for most people and is always the starting point:
- A thumb spica splint that rests the thumb and wrist, worn for several weeks, particularly during aggravating activities.
- Activity modification, including practical techniques for lifting and feeding a baby with less strain on the thumb.
- Hand therapy and, once pain settles, gentle stretching and strengthening.
- A corticosteroid injection into the tendon sheath, which brings lasting relief for a high proportion of patients. If you are breastfeeding, the suitability of an injection and any medication is discussed carefully with you.
In new mums, De Quervain's tenosynovitis frequently eases as the baby grows and hormone levels settle, so patience and protection are often rewarded. Surgery is considered only when pain persists despite these measures, usually after one or two injections and several months of symptoms.
03Your Consultation on Harley Street
Your consultation takes place at 64 Harley Street, Marylebone, where Ms De Leo sees every patient personally. The practice is open every day by appointment, which makes it easier to fit a visit around feeds, naps and work.
She will listen to how the pain affects your days and nights, examine both wrists, and explain the diagnosis and treatment options in clear, practical terms. If an injection is appropriate, it can often be given during the same visit, guided by careful anatomical landmarks or ultrasound where helpful. For parents, the conversation also covers small changes in lifting and holding that protect the tendons while they heal; our post-pregnancy programme considers recovery after childbirth more broadly.
Patients often ask about De Quervain's surgery cost factors. Your personalised plan is shaped by whether imaging is required, whether treatment is an injection or a release, the facility used and any hand therapy afterwards, all explained clearly in advance. For anyone looking for a hand specialist near Marylebone or in central London, the practice is close to Regent’s Park, Baker Street and Oxford Circus.
04De Quervain's Release: How Surgery Is Performed
When conservative care for De Quervain's tenosynovitis has not worked, a De Quervain's release (first dorsal compartment release) is a short, well-established procedure. It is usually performed under local anaesthetic as a day case, so you can go home soon afterwards.
- The skin over the thumb side of the wrist is numbed with a fine injection.
- A small incision, around two centimetres long, is made over the compartment, ideally placed within a natural skin crease.
- The delicate branches of the superficial radial nerve, which supply feeling to the back of the thumb and hand, lie just beneath the skin here. Under magnification, they are identified and gently protected throughout.
- The roof of the compartment is opened so that the tendons can glide freely. Many people have a separate inner partition around one of the tendons; this is carefully looked for and released, as missing it is a recognised cause of persistent symptoms.
- Tendon movement is checked, and the skin is closed with fine sutures.
This is precisely the kind of operation where Ms De Leo’s microsurgical training and hand surgery expertise matter: small nerves, small spaces and a result that depends on attention to detail.
Mummy’s thumb deserves more than ‘it’ll pass’: the right splint, advice and, when needed, precise treatment let you hold your baby without pain.
ADLSynergy · Harley Street
05Recovery After De Quervain's Surgery
Recovery is generally straightforward, and the sharp pain of De Quervain's tenosynovitis usually eases quickly once the compartment is released.
- First few days: keep the hand elevated and the dressing dry; move the fingers and thumb gently. A soft dressing or light splint may be used briefly for comfort.
- Days 3–14: light use of the hand for everyday tasks; avoid heavy lifting and forceful gripping. New parents are advised on safe ways to handle their baby during this time, ideally with extra help at home for the first days.
- At 10–14 days: wound check and suture removal.
- Weeks 2–6: desk work is typically resumed within one to two weeks; gradual return to strengthening and normal activities.
- Weeks 6–8: most people are back to full use, including sport and manual work, although some tenderness over the scar can persist for a little longer.
Scar massage and desensitisation help the area settle. Follow-up is arranged at our Harley Street clinic in London, and the ADLSynergy team can support scar therapy and recovery.
06De Quervain's Tenosynovitis Treatment: Risks and Results
Both injection and surgical release have good success rates for De Quervain's tenosynovitis, but results vary and no treatment is without risk. Steroid injections can occasionally cause thinning or lightening of the skin at the injection site and a temporary flare of pain.
Possible risks of surgery include:
- Infection, bleeding or a tender, sensitive scar.
- Irritation or injury of a superficial radial nerve branch, causing numbness, tingling or a painful neuroma; careful technique makes this uncommon.
- Incomplete relief, for example if a separate subcompartment is present and not released.
- Tendons slipping over the edge of the wrist bone (subluxation), which is rare.
- Stiffness or complex regional pain syndrome, both uncommon.
For most patients, the meaningful “before and after” is simple: lifting a child, a pan or a bag without that sharp catch of pain.
07Why Choose Ms Anna De Leo on Harley Street
Ms Anna De Leo holds the European Diploma in Hand Surgery, an International Master’s Degree in Reconstructive Microsurgery and a Diploma in Microsurgical Techniques, and is a Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery. She has more than twenty years of experience across Italy, Europe and London NHS hospitals, including Chelsea and Westminster, the Royal Free and Oxford University Hospitals.
As a female surgeon who understands the realities of caring for a young family, she offers practical, unhurried advice and a firmly conservative philosophy, recommending surgery only when simpler measures have been given a fair chance. Find out more about Ms Anna De Leo and the Harley Street practice in London, or book a consultation to discuss De Quervain's tenosynovitis treatment.
