Beat Gamer’s Thumb: How the Finkelstein Stretch Eases De Quervain’s Pain

De Quervain’s tenosynovitis [1], also known as gamer’s thumb, is an inflammatory condition that affects the two tendons; abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), on the thumb side of your wrist (Bailey, 2023).

De Quervain’s tenosynovitis is a condition that causes pain and inflammation in the tendons at the base of the thumb. It’s also known as “caregiver’s wrist”, “Texter’s thumb”, and “gamer’s thumb”.

It is considered to be very painful and that pain is felt when you turn your wrist, grasp anything or make a fist.

A tendon sheath is a protective covering that allows you to turn your wrist, grip it, and pinch your hand.

It makes the tendons slide easily as you stretch, turn and maneuver through the motion.

The tendon sheath may be thin but composed of fibrous and synovial layers. 

These are flexible layers that move as the tendons move, commonly associated with gamer’s thumb.

However, it can get inflamed, causing pain and discomfort.

Those playing sports with rackets, lifting their baby, playing golf, or working in the garden that involves repetitive hand or wrist movement suffer from De Quevain’s tenosynovitis. 

It is also evident in those using a hammer, carrying heavy groceries or bags, typing, and knitting.

De Quervain’s Tenosynovitis Signs and Symptoms

De Quervain’s tenosynovitis may cause different symptoms, such as:

• Pain at the side of your wrist under the base of your thumb
• Also, movement on your thumb exacerbates the pain.
• Pain on the wrist that has spread into your thumb and forearm.
• Mild wrist swelling, redness, or warmth
• Formation of a fluid-filled cyst near the side of your wrist.
• Pain along the back of your thumb, directly over the two tendons.

The condition, often referred to as “gamer’s thumb,” can ensue gradually or happen suddenly.

Regardless, the pain may start from your thumb or up your forearm. 

It may be painful to move your thumb, especially when you try to pinch or grasp things.

The pain is worse when you move your thumb or wrist.

How Is De Quervain’s Tenosynovitis Diagnosed?

Some may have X-rays done, but it is not necessarily needed to diagnose the condition ^[2].

Your doctor may perform a simple test to diagnose De Quervain’s tenosynovitis. 

The test is called the Finkelstein Test. You might be asking…

What is The Finkelstein Test?

The Finkelstein Stretch is a simple test and therapeutic stretch used to assess and relieve symptoms of De Quervain’s Tenosynovitis (Challoumas et. al. 2023).

It is often used by healthcare professionals as a diagnostic test, it can also help alleviate symptoms when done gently as part of therapy.

When the test is done in a healthy wrist, this creates a mild stretch sensation, commonly used to assess for conditions like gamer’s thumb.

However, if De Quervain’s Tenosynovitis is present, it can cause sharp pain along the tendons, indicating irritation or inflammation.

If there is intense pain, the stretch should be done with caution, as aggressive stretching can worsen inflammation.

Here’s how you perform the test:

• Bend your thumb so it rests across your palm.
• Bend your wrist toward your little finger. 
• Then you make a fist, closing your fingers over your thumb.

How to interpret the result:

• Negative result: No pain/ radiating pain is felt on the inside of your arm from the thumb.
• Positive result: If you felt tenderness or pain at the base of your thumb. It can be felt up the inside of your arm from the thumb.

Your condition’s symptoms ^[3] and physical condition will help see if you have de Quervain’s tenosynovitis.

They will also ask you to do certain movements with your hand, wrist, and thumb to evaluate for conditions like gamer’s thumb.

De Quervain’s Tenosynovitis Treatment

De Quervain’s tenosynovitis treatment is focused on the following:

• Pain and swelling reduction
• Maintain normal joint function
• Preventing the recurrence of the condition

Pain and swelling reduction treatment include:

• Ice or heat application to the affected area

When Using Heat: Fill a water bottle with warm water and place it on your wrist. 

• You may also use a heating pad. 
• Ensure the water bottle or heating pad isn’t too hot before putting it on your wrist. 
• Apply it for 15 minutes every 4 to 6 hours. 
• Don’t leave the water bottle or heating pad on for over 15 minutes.

When Using Ice: Apply an ice pack for 10 to 15 minutes every 4 to 6 hours.

• Nonsteroidal anti-inflammatory drug (NSAID) medication such as ibuprofen (Advil, Motrin) or naproxen (Aleve).
• Refrain from repetitive hand and wrist motions or activities that may cause pain and swelling.
• Wearing a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.
• Getting steroid injections or a local anesthetic (numbing medicine) into the tendon sheath. These injections are effective in reducing pain and swelling.

For De Quervain’s case, exercise is important in maintaining normal joint function and preventing the recurrence of the condition.

While recovering from gamer’s thumb, it will help you to do your daily activities while wearing a splint.

Adjust your home and work activities to lessen the stress on your wrist and prevent gamer’s thumb.

Most people notice improvement after 4 to 6 weeks of treatment. 

Once you can use your hands and wrists without pain with the swelling is gone, you should start doing exercises. 

Do exercises to strengthen your arm, wrist, and hand while you recover.

Home Exercises For De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis strengthening exercises have been shown to speed up the healing process (Goel & Abzug, 2015).

It also helps in reducing your symptoms.

In doing De Quervain’s Tenosynovitis exercises, you’ll need these types of equipment:

• Putty Ball/Squeeze Ball
• Elastic Resistance Band
• Rubber Band
• Small Weight

Without a small weight, you can use a can of food, a hammer, or a water bottle filled with water, sand, or rocks.

These De Quervain’s tenosynovitis exercises can be done a few times throughout the day. In doing so, make sure to listen to your body.

It should not cause any additional stress on the healing tendon sheath.

Meanwhile, if this does happen, you may need to lessen the repetitions, or you can rest on alternate days.

When exercising, only stretch as far as the end of the range possible without pain. 

However, don’t force yourself into assuming any position.

Also, refrain from jerky movements to avoid gamer’s thumb by making the movement slow and smooth.

De Quervain’s Tenosynovitis Exercises

1. Thumb Lifts

• In this De Quervain exercise, start with your hand on a flat surface with your palm facing up. Rest the tip of your thumb at the base of your fourth finger.
•  Lift your thumb away from your palm so it’s nearly perpendicular to the forefinger side of your hand.
• You’ll feel a stretch at the back of your thumb and across your palm.
• Keep your thumb extended for about 6 seconds and release. Repeat 8 to 12 times.
• Then, place your hand on a table with your palm facing up. Lift your thumb and your pinky.
• Gently press the tips of your thumb and pinky together.
• You’ll feel a stretch at the base of your thumb.
•  Hold this position for 6 seconds. Lastly, release and repeat 10 times.

2. Opposition Stretch

• Firstly, start by resting your hand on a table with your palm facing up.
• Touch the tip of your thumb to the tip of your little finger.
• Hold this position for 6 seconds and then release. Repeat 10 times.

3. Thumb Flexion/Extension

For this exercise, you can place your hands on the table or hang them at your side as you perform this movement.

• Firstly, Bend your thumb downward and across your palm so that your thumb touches the base of your little finger.
• Hold that position for about 6 seconds.
• Then, straighten your thumb. Repeat 8 to 12 times. Switch hands, and repeat steps 1 through 3.

4. Finkelstein Stretch

• Hold your arms out in front of you. (Your hand should be in the position used for shaking someone’s hand.)
• Then, bend your thumb toward your palm. Use your other hand to gently stretch your thumb and wrist downward until you feel the stretch on the thumb side of your wrist.
•  Hold for at least 15 to 30 seconds. Repeat 2 to 4 times.

5. Wrist Flexion

• Hold a can or hammer handle with your palm facing up to help alleviate gamer’s thumb.
• Then, bend your wrist upward. Slowly lower the weight and return to the starting position.
• Do 2 sets of 15. Gradually increase the weight of the can or weight you are holding.
• And finally, as you get stronger, you can gradually increase your weight.

6. Wrist Extension

• For this De Quervain exercise, extend your arm with your palm facing down.
• Hold a small weight as you slowly bend your wrist up and back.
• You’ll feel a stretch at the back of your hand and wrist.
• Then, slowly bring your wrist back to its original position.
• Do 2 sets of 15. You can gradually increase the weight as you gain strength.

7. Wrist Radial Reviation Strengthening

• Extend your arm before you, palm facing inward while holding a weight.
• Your thumb should be on top.
• Then, balance your forearm on a table and your wrist positioned over the edge if you need extra support.
•  Keeping your forearm still, gently bend your wrist with the thumb moving toward the ceiling.
• You’ll feel a stretch at the base of your thumb where it meets your wrist. Slowly lower your arm back down to the original position. After that, do 2 sets of 15.

8. Eccentric Radial Deviation Strengthening

• Firstly, sit on a chair with your legs spread slightly open.
• Grasp one end of an elastic band with your right hand.
• Then, lean forward, put your right elbow on your right thigh, and let your forearm drop between your knees.
• Step on the other end of the elastic band using your left foot.
• With your palm facing down, slowly bend your right wrist to the side, away from your left knee.
• You’ll feel a stretch at the back and the inside of your hand. Repeat 8 to 12 times.
• Lastly, repeat this exercise on your left hand.

9. Grip Strengthening

• Squeeze a putty ball for five seconds at a time. Do 2 sets of 15. 
• Then, place a rubber band or hair tie around your thumb and fingers.
• Make sure the band is tight enough to offer some resistance.
• Open your thumb to stretch the rubber band as far as you can.
• You’ll feel a stretch along your thumb. Do 2 sets of 15.

10. Finger Spring

• Place a large rubber band around the outside of your thumb and fingers.
• Then, open your fingers to stretch the rubber band. Do 2 sets of 15.

Conclusion

De Quervain’s tenosynovitis is a temporary condition. 

It generally responds well to treatment. 

So it is essential to treat de Quervain’s tenosynovitis. 

If this condition isn’t treated, it can permanently limit your movement or cause the tendon sheath to burst.

Once your symptoms are better, work to prevent the condition from happening again. 

You’ll likely make a full recovery with treatment. 

If the activities that caused the condition aren’t stopped, problems may arise. 

Therefore, the damage to your tendon may become permanent.

Over time, it can impact your mobility.

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FAQs

1. What is The Patient Asked To Do During the Finkelstein Test?

• The patient will be asked to do a series of hand movements to test whether or not they are suffering from De Quervain’s Tenosynovitis.
• Specifically, the patient is asked to make a fist with their thumb tucked inside their fingers, then gently bend their wrist toward the pinky side.
• This movement places strain on the affected tendons, which may cause sharp pain if De Quervain’s Tenosynovitis is present.

2. How To Perform a Finkelstein Test?

• First, bend your thumb so it rests across your palm.
• Then, bend your wrist toward your little finger.
• Finally, you make a fist, closing your fingers over your thumb.

3. What is The Purpose of The Finkelstein Test?

• The main purpose of the Finkelstein Test is to diagnose De Quervain’s Tenosynovitis.
• By stretching the tendons along the thumb side of the wrist, the test helps healthcare providers determine if there is significant irritation or inflammation.

4. What Should You Expect to Feel During the Finkelstein Test?

• Without De Quervain’s: Most people without the condition feel a mild stretch without pain.
• With De Quervain’s: Individuals with the condition may feel sharp, intense pain along the side of the wrist, indicating inflammation or irritation.

5. Is the Finkelstein Test Painful?

• The test may be uncomfortable if inflammation is present.
• People with De Quervain’s often experience sharp pain, while those without it feel only a mild stretch.