Osteoarthritis Clinic · Home exercise program

De Quervain's tenosynovitis

Wrist and thumb tendon pain

Gentle exercises and simple aftercare to follow at home after your corticosteroid injection. Start slowly, build up as comfort allows, and stop anything that causes sharp pain.

Corticosteroid injectionDepo-Medrol (methylprednisolone acetate)
About this conditionAll patient guides
Reviewed
Reviewed. The exercises, repetition counts, hold times, and order of the exercises on this sheet have been checked by Dr. Mahendira against the clinic's printed handout.
SMH Osteoarthritis Clinic · De Quervain's tenosynovitis · Corticosteroid injection (Depo-Medrol (methylprednisolone acetate))
Reviewed by Dr. Mahendira against the clinic handout.

Your injection

A long-acting corticosteroid injected into the first dorsal compartment of the wrist, surrounding the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. It reduces inflammation and swelling of the tendon sheath, relieving the pain and difficulty with thumb and wrist movement that is typical of De Quervain's.

After your injection

What to expect

  • Mild soreness at the thumb side of the wrist is normal for 24 to 48 hours (a steroid flare).
  • The Depo-Medrol usually begins working within 3 to 7 days. Full effect may take 2 to 3 weeks.
  • Pain with thumb movement and the Finkelstein test should gradually improve.
  • Success rate is roughly 70 to 80% with a single injection for De Quervain's.

First 24 hours

  • Rest the wrist and thumb. Avoid gripping, pinching, twisting, and lifting.
  • Apply ice wrapped in a cloth for 10 to 15 minutes every 2 to 3 hours to the thumb side of the wrist.
  • Keep the injection site clean and dry.
  • Take acetaminophen (Tylenol) as needed. Avoid NSAIDs for 24 hours unless directed.

Days 2 to 14

  • Gradually resume light daily activities as comfort allows.
  • Continue to avoid forceful gripping, twisting, and repetitive thumb use for at least 1 week.
  • Begin gentle tendon gliding and range of motion exercises after 48 hours.
  • Wear your thumb spica splint during activities and at night as directed by your provider.

Important reminders

Limit injections to 2 to 3 for this condition. Repeated corticosteroid injections near tendons may cause weakening or rupture of the tendons. If injections do not help, release of the first dorsal compartment may be recommended.

Your exercises

Begin gently after about 48 hours if you are comfortable. Move slowly and stay within a mild, pain-free range. The counts below are a guide for how much to do.

1

Thumb flexion and extension

Foundation

Hold your hand in a relaxed, upright position. Slowly bend the thumb across the palm toward the base of the pinky, then return to the starting position. Move in a slow, controlled arc.

2 sets of 10 reps, 3x daily

This is the foundation exercise. Perform it before all others.

2

Thumb opposition touches

Touch the tip of your thumb to the tip of each finger in sequence (index through pinky), forming a round O shape each time. Then reverse direction. Focus on smooth, pain-free motion.

2 sets of 5 cycles, 2 to 3x daily

Gently stretch into each O. Do not force.

3

Wrist radial and ulnar deviation

Rest your forearm on a table with your hand over the edge, thumb facing up. Slowly tilt your hand upward (toward the ceiling), then downward (toward the floor). This targets the affected compartment directly.

2 sets of 10 reps, 2x daily

Keep the forearm flat and still. Move only the wrist.

4

Finkelstein stretch (gentle)

Start after week 2

Tuck your thumb into your palm. Gently curl your fingers over the thumb. Slowly tilt the wrist toward the pinky side until you feel a mild stretch on the thumb side. Hold 10 to 15 seconds.

3 reps of a 15 second hold, 2x daily

Start after week 2. Stop if sharp pain occurs.

5

Thumb abduction (spread)

Place your hand flat on a table, palm down. Slowly move your thumb away from your hand as far as comfortable, then return. Strengthens the abductor pollicis longus in a controlled way.

2 sets of 10 reps, 2x daily

Keep fingers flat on the surface.

6

Wrist flexion and extension

Rest your forearm on a table with your wrist at the edge, palm facing down. Slowly bend the wrist up (extension) and then down (flexion) through full comfortable range.

2 sets of 10 reps, 2x daily

Maintains general wrist mobility during recovery.

7

Isometric thumb extension

Start after week 2 to 3

Place a rubber band around your thumb and index finger. Gently push your thumb away from the index finger against the band resistance. Hold 5 seconds, release slowly. Builds tendon strength gradually.

2 sets of 8 reps, 1 to 2x daily

Start after week 2 to 3. Use a light band first.

Exercise guidelines

  • Stop any exercise that causes sharp or increasing pain at the thumb side of the wrist.
  • Soak your hand in warm water for 5 minutes before exercises to loosen the tendons.
  • Mild discomfort is fine. Sharp or worsening pain is not. Stay at 3 out of 10 or below.
  • Consistency matters most. Perform exercises daily for best results.

Protecting the area every day

  • Avoid repetitive thumb motions: pinching, wringing, twisting, and scrolling on your phone with the thumb.
  • Lift objects with your palm facing up (an underhand grip) to reduce strain on the thumb-side tendons.
  • Use your whole hand or both hands to pick up children, heavy pots, and laundry rather than gripping with the thumb.
  • Take breaks every 10 to 15 minutes during repetitive hand tasks such as typing, knitting, or gardening.
  • Avoid sustained wide thumb positions. Holding a large book open or a wide phone one-handed strains the tendons.
  • Use ergonomic tools with large, padded handles to reduce the force needed by the thumb and wrist.
  • Apply ice for 10 to 15 minutes to the thumb side of the wrist after any aggravating activity.
  • New parents: support your baby's head with a pillow or forearm rather than with an extended thumb and wrist.

Thumb spica splint

Wear it as directed, especially during aggravating activities and at night. The splint immobilizes the thumb and wrist, allowing the inflamed APL and EPB tendons to settle.

Tracking your progress

Tick a box each day you complete your exercises, and circle how the area feels.

 MonTueWedThuFriSatSun
Week 1
Week 2
Week 3
Week 4
Pain level today (circle one)
012345678910
0 = none10 = worst
!When to call your doctor. Contact the clinic or seek care if you notice any of the following: Increasing pain, swelling, or redness at the thumb side of the wrist lasting more than 48 hours; Fever above 38C (100.4F), which may signal infection in the tendon sheath. Seek care urgently; Numbness, tingling, or weakness in the thumb, index, or middle finger (possible nerve involvement); Skin changes near the injection site: lightening, thinning, or a visible depression; A snapping or catching sensation in the tendons that was not present before the injection; Symptoms of high blood sugar in people with diabetes: excessive thirst, frequent urination, blurred vision; No improvement in pain or function after 3 to 4 weeks.
This is general information, not medical advice. Your exercises and recovery depend on your own situation, and your clinician will guide you.

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