Question 1

De Quervain's Tenosynovitis

Accepted Answer

What is De Quervain’s Tenosynovitis? 
https://static.wixstatic.com/media/e7d8af_9eaa3f0a1f5b484294125287476396d3~mv2.png

De Quervain’s tenosynovitis is a condition where two tendons become irritated when they enter a tunnel around the wrist and thumb. The sheath that cover the tendons become inflamed and painful. De Quervain’s is not harmful, but can be troublesome.

Causes:

The exact cause of De Quervain's tenosynovitis is unclear in many cases. However, repetitive thumb and wrist movements, such as lifting babies or using scissors, can contribute to its cause.

Symptoms:

·      Swelling over the thumb side of the wrist and lower forearm, specifically at the 
point of pain. 
·      Tenderness at the base of the thumb and wrist.
·      Occasional clicking or snapping of the tendons.

Treatment:

·      A thumb splint can be used to rest the tendons and ease the pain. 
·      An exercise program will help maintain the movement in your thumb.
·      Avoiding strenuous activity, heavy lifting or activities that produce the symptoms, 
may settle the inflammation. 
·      Anti-inflammatory gel/medication may help to reduce the pain and inflammation.

If your symptoms fail to settle, steroid injections can be an effective way to treat this condition. Surgery can also be considered if all other methods have failed.

Exercises:

Complete the exercises below 3-4 times a day, 5-10 repetitions for each exercise. The suggested repetitions are a guide only. If you are unable to tolerate the pain, then reduce the repetitions or stop.

1.
https://static.wixstatic.com/media/e7d8af_c9b040a0af294856ba495aacc2324a3e~mv2.jpg

Bend the tip of the thumb, gently rest on the middle of your middle of your index finger. Keep the tip in this position, and gently rock the thumb side to side.

2.
https://static.wixstatic.com/media/e7d8af_ba95b550f6694374882d2935910fd050~mv2.jpg

Bend the tip of the thumb, keeping in this position; gently lift the thumb up with your non-affected hand.

Slowly lower the affected thumb back down without help.

3. 
https://static.wixstatic.com/media/e7d8af_f0d463c61f3a49eabf623fdca5664e91~mv2.jpg
https://static.wixstatic.com/media/e7d8af_8c6c52ba025d4e38abae921ecaae6751~mv2.jpg

Start with your hand in a straight position.

Move your thumb away from your palm, hold for 5 seconds, then move it back to the straight position.

Further Resources: 
https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome (https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome)

Last reviewed Dec 2025. To be reviewed Dec 2026.

Question 2

Distal Radius Fracture

Accepted Answer

What is a distal radius fracture? 
Distal Radius fracture is when the larger bone in the forearm (the radius) is broken at the end closest to the wrist.

The end of the bone towards the wrist is called the distal end. The ulna is the smaller of the two bones of the forearm, the tip of this is often broken as well; this is called an ulna styloid fracture.

Causes:

Most wrist fractures occur from falling onto an outstretched hand. Fractures can occur even in healthy bones, particularly when there is severe trauma, such as with car accidents or falls from a height.  
Weak bones (for example, osteoporosis) tend to break more easily. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

Symptoms:

• Pain 
 • Aching/stretching sensations 
 • Swelling 
 • Bruising 
 • Deformity 
 • Dry skin 
 • Reduced hand and wrist movement

Treatment:

If the forearm bones are in a good position after the fracture, a cast is normally applied until the bone heals (approximately 4-6 weeks). It is normal to feel some pain and discomfort after the cast has been removed, as your hand and wrist will feel stiff and vulnerable.  You may be given a temporary splint for comfort when your cast is removed; do not wear this all the time as it will restrict your movement and delay the recovery process.

General Advice:

• Swelling is common and will reduce your normal wrist movement. Try to keep your hand elevated above heart level and do your hand exercises regularly. Do not keep your arm down at your side for long periods, as this may increase the swelling in your hand.  
 • It is important to get as much movement back into your wrist as soon as you can. 
 • You can use your hand for light tasks; heavy repetitive tasks should be avoided for the first 10-12 weeks.  
 •  Do not drive in your cast or splint. When your cast is removed you need to be sure you have enough strength and control to drive safely. 
 • Most people return to work once the cast is removed. It is usually about 12 weeks after the injury before you can return to a heavy manual job.

Exercises:

It is normal to feel a stretch and/or discomfort when doing the exercises, but they should not be painful. Please perform the exercises 4-5 times a day, 5-10 repetitions of each one. This is only a guideline and can be varied depending on your level of pain and stiffness.

1.
WRIST FLEXION / EXTENSION:  
 
With your forearm supported on a table. Bend your wrist up and down, do some with your fingers straight and some with your fingers bent.

https://static.wixstatic.com/media/e7d8af_9b77d8162fb64e10bda5adf73708f790~mv2.png
https://static.wixstatic.com/media/e7d8af_2ea77a4d836e4c23b4e0454fb669f783~mv2.png

2. 
WRIST ULNAR AND RADIAL DEVIATION:  
With your forearm supported on a table. Move your wrist from left to right, 
as if waving.

https://static.wixstatic.com/media/e7d8af_014cc99520154595b38157450277cc3d~mv2.png
https://static.wixstatic.com/media/e7d8af_48c70f6e29c74c6babdd8b488f051634~mv2.png

3.
FOREARM SUPINATION AND PRONATION: 
 
With your forearm supported on a table, keep your elbow tucked into your side.
Turn your hand over.

https://static.wixstatic.com/media/e7d8af_fc894fb78ed3439a84788329f190362b~mv2.png
https://static.wixstatic.com/media/e7d8af_8746aca9cef145b7921d33da47f6e12a~mv2.png

Additional Exercises:

Please perform the exercises below 5 times a day, hold each position for 5-10 seconds, repeat 5 times.   
This is only a guideline and can be varied depending on your level of pain and stiffness.

1. 
Put your hands together in a prayer position; keep your palms together.       
 
Slowly lower your hands, moving your elbows out to the side.

https://static.wixstatic.com/media/e7d8af_f5f3f8313d3d4576921a5fae23e5c65a~mv2.png

2. Keep your elbow against your side. Start in a handshake position. Turn your forearm so your hand is facing palm up. Using your other hand (as shown) apply pressure to assist pulling your forearm further around. Keep your elbow still during this movement.

https://static.wixstatic.com/media/e7d8af_4f0d3ec4601c4f42ab8af384c5a84c69~mv2.png

Last reviewed Dec 2025. To be reviewed Dec 2026.

Question 3

Osteoarthritis of the Thumb

Accepted Answer

What is Thumb Osteoarthritis?
https://static.wixstatic.com/media/e7d8af_9eaa3f0a1f5b484294125287476396d3~mv2.png

Thumb osteoarthritis (Carpometacarpal Joint (CMC joint) is the joint at the base of the thumb.

Osteoarthritis at this joint is the gradual wearing away of the cartilage covering the ends of the bones at the joint (the trapezium and the first metacarpal). This leads to the trapezium and the first metacarpal bones rubbing together, causing pain and making it difficult for you to use your thumb.

Causes:

People who have had previous trauma or surgery to the thumb, are female and who have used the thumb repetitively through occupational or leisure activities, are more likely to develop osteoarthritis in later life.

Symptoms:

• Achy or sharp pain at the base of the thumb, particularly during pinching and gripping activities
 • Swelling 
 • Weakness
 • Stiffness

Diagnosis:

A description of symptoms and a physical examination are required for diagnosis.  Occasionally an X-ray is taken.

Activity Modification and the use of small aids:

Modifying the activities that aggravate your thumb helps protect the joint from further damage and lessen your pain.

Spread the load over several joints and use two hands where possible.

Don’t lift heavy objects if you don’t have to and reduce the weight of what you lift if possible

Pacing: Breaking activities up into smaller tasks, particularly heavier activities, may reduce the strain and pain on the carpometacarpal joint. For example, instead of carrying out heavy gardening tasks for long periods of time, take regular breaks or alternate heavier tasks with lighter ones.

Small aids:
Using aids can make tasks easier and can increase your independence.

Examples of these are:

• Multi opener (assists with bottle tops, cans, safety seals, jar lids, bottle caps, sealed bags)
 • Silicon jar openers
 • Large handled cutlery
 • Key turners
 • Pen grips/Yoropen
 • Spring action scissors
 • Electric tin openers
 • Plug pulls 
 • Finger hold peelers
 • Pill poppers
 • Button Hook
 • Contour turners (assists turning knobs)
 • Shoe horns

These items can be purchased online and some large handled items can be purchased in homeware shops.

Treatment:

A holistic approach is the best way of treating CMC joint osteoarthritis.  This includes: exercises, activity modification, use of assistive devices, and pain relief.  Splints or pressure gloves can also help.

Splints and pressure gloves (or arthritis gloves) are useful for some patients. The role of splints and gloves are predominantly to support the small joints, but can sometimes be used for protection.

How do I look after my splint or gloves?

All splints and gloves should be washed regularly in luke-warm soapy water, but some may be able to go in the washing machine on a gentle wash. Do not leave your splint or glove near a naked flame or try to adjust the splint yourself.

When do I wear my splint or gloves?

Try to identify the times of day or specific activities that increase the pain in your thumb and wear it for this period of time. You can alternate splints or gloves depending on the activity. Do not wear two splints at the same time and make sure you do not wear the splint or gloves ALL the time.

REMOVE THE SPLINT OR GLOVE IMMEDIATELY IF YOU EXPERIENCE ANY RASH, RUBBING, BROKEN SKIN OR IRRITATION OF YOUR SKIN FROM THE SPLINT.

Many patients with osteoarthritis find that heat can relieve pain. This can come in several forms;

·       Hot water bottles
·       Rice bags or wheatie bags
·       Thermal gloves or skiing gloves
·       Wax baths

Try to use heat first thing in a morning or before a specific activity that may aggravate the joint. 
Always test the water temperature prior to use. Do not use heat if you have an open or unhealed wound, or altered sensation in your hands.

Steroid injections or surgery may be considered if you feel your symptoms are no longer being managed conservatively.  There are various surgical methods used in the treatment of thumb CMC joint osteoarthritis, which your hand surgeon would discuss with you.  The most common being:

• Trapeziectomy (where the trapezium bone is removed from the base of the thumb)
 • Fusion (where the 1st metacarpal and the trapezium bones are fused)
 • Joint replacements

Exercises:

Please perform the exercises below twice a day, 5-10 repetitions of each exercise. 
This is a guideline only and can be varied depending on your level of pain and stiffness.

https://static.wixstatic.com/media/e7d8af_f81f9959a342435c82d3d78f87aec941~mv2.png
https://static.wixstatic.com/media/e7d8af_03306d9deeae4716a5c61f9f93666f19~mv2.png

Place your hand flat on a table with your palm facing downwards. 
Move your thumb away from your index finger and back again.

https://static.wixstatic.com/media/e7d8af_fa57c57b43aa40e3aa2f7c2ef0e2b0e1~mv2.png

https://static.wixstatic.com/media/e7d8af_3d02a7d0bfdd4a6ab81fc14572ff9201~mv2.png

Hold your thumb still under the top joint. 
Bend and straighten the top joint of your thumb.

https://static.wixstatic.com/media/e7d8af_66addd76cab34273acce112425cf132c~mv2.png

https://static.wixstatic.com/media/e7d8af_994b90117c7447878b56902b1689b0fe~mv2.png

Hold your thumb as shown in the picture above. 
Bend the thumb tip towards the base of little finger.

https://static.wixstatic.com/media/e7d8af_60bf92fd48b045a8aae587f69e943fc8~mv2.png

Touch each fingertip with the tip of your thumb, creating an “O” shape.

Further Resources:
https://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis (https://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis)

http://versusarthritis.org (http://versusarthritis.org/)

Last reviewed Jan 2026. To be reviewed Jan 2027.

Question 4

Thumb Pain Exercises

Accepted Answer

Sometimes you may experience thumb pain after an injury or repetitive motions.

Reviewed Jan 2026. Due to be reviewed Jan 2027.

Question 5

Dupuytren's and Surgery

Accepted Answer

What is Dupuytren’s?

Dupuytren’s  presents as firm nodules beneath the skin in the palm of the hand. In some cases, they develop to form cords that prevent the finger or thumb from fully straightening.

Causes:

It is a common condition that usually occurs in middle age or later in life, and is more prevalent in men than women.

Symptoms:

• Firm nodule beneath the skin in the palm of the hand.

Management following surgery:

Swelling Management

• It is normal to have ongoing swelling after your surgery. There are some simple techniques to encourage the swelling to reduce;
 • Move your fingers regularly 
 • Keep your arm elevated above the level of your heart when resting in the first few weeks after surgery. 
 • Do not keep your arm down by your side for long periods of time.

Wound Management:

On your first appointment, your bulky dressing from surgery will be replaced with a lighter dressing. It is important that you keep the dressings clean and dry. Do not adjust the dressings yourself without medical advice.

If you are experiencing any of the symptoms below, please seek medical advice as soon as possible.

• Increased redness
 • Increased heat
 • Increased pain
 • Increased swelling
 • Discharge from the wound
 • General feeling of being unwell
 • A bad odour coming from the wound

Once your wound is fully closed and dressings are no longer required, start washing your hand under running water only, do not soak the wound. Pat your wound dry with a clean towel.

Scar Management

Scars are a normal part of the healing process. However, sometimes scars can become thickened, lumpy and stick to surrounding soft tissues, which, may restrict movement. Regular massage using non- perfumed moisturiser for at least 10 minutes per day is recommended to prevent this occurring.

Splint

You will be provided with a thermoplastic splint to wear at night only.  The splint helps extend your finger and to keep it in a good position at night. It is important that you;

• Clean the splint with warm soapy water or a baby wipe regularly.
 • Make sure your splint does not get too hot, e.g. In a bath or on a radiator.
 • Must not drive with the splint on. 
 • Use your hand for light activities during the day. 
 • Do not adjust the splint yourself.
 • Wear the splint at night for up to twelve weeks after your surgery.
 
Bring your splint with you to every appointment as it will likely require remoulding.

If the splint starts to rub or if you feel that it no longer fits, please contact the hand therapy team as soon as possible.

Further Resources:

• https://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease (https://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease)

Last reviewed Dec 2025. To be reviewed Dec 2026.

Question 6

Mallet Finger

Accepted Answer

What is  Mallet Finger?
A mallet finger is when the fingertip hangs down towards the palm and cannot be straightened using your muscles.

Causes:
It is usually caused when the fingertip is forced to over bend.
There are two types of mallet finger:

1.    Soft tissue mallet: This is when there is a tear to the tendon that straightens the end of the finger.

2.    Bony mallet: 
This is when the tendon pulls a small piece of bone off, and uses a fracture. An x-ray will confirm if this has occurred.

Symptoms:

• Pain
 • Swelling
 • An inability to straighten the fingertip

Treatment:

The injured finger is placed in a plastic splint to hold the end joint in a straightened position. This allows the tendon ends, or bone, to stay in a good position for healing. If the end joint of the finger is not held straight at all times, the end of the finger is likely drop and is unlikely to heal.

Your splint must be worn at ALL times, day and night.

·       For soft tissue mallet injuries, wear the splint for at least 8 weeks.

·       For bony mallet injuries, wear the splint for at least 6 weeks.

When you tape your splint to your finger, make sure that the middle joint if left free.

If you want to clean your finger, wash it on a flat surface. Do not lift your hand off the table without supporting the fingertip with your other hand. You must keep your end joint straight at all times.

DO NOT try to test your finger bybending it or pushing it down at any time.

If the mallet splint provided in A&E does not fit well, you may be referred to Hand Therapy for a custom-made splint.

Exercises:

It is important to maintain movement in your fingers and to continue using your hand functionally.
Do the exercises below with the splint on:

Perform 5-10 repetitions, 3-4 times a day, straightening the fingers up after each bend.

https://static.wixstatic.com/media/e7d8af_717f046de2804e9da64d1609b879a209~mv2.png
https://static.wixstatic.com/media/e7d8af_35741774a7514e0c8c8236546456988b~mv2.png

https://static.wixstatic.com/media/e7d8af_720e176f9483476f8036c7e4b76f94b0~mv2.png

Expectations:

A good outcome is a straight fingertip, but sometimes a small drop of the fingertip may be present long term. Swelling, redness and tenderness can often continue around the end joint for a few months, but these symptoms eventually settle. It is normal for bony mallet injuries to leave a small bump over the joint, but this should not affect finger function.

Further Resources:
https://www.bssh.ac.uk/patients/conditions/28/mallet_finger_injury (https://www.bssh.ac.uk/patients/conditions/28/mallet_finger_injury)

Last reviewed Dec 2025. To be reviewed Dec 2026.

Question 7

Trigger Finger

Accepted Answer

What is Trigger Finger?

Trigger finger is a condition that causes catching or locking of a finger when it is bent into a fist or straightened.

There are several tunnels (pulleys) that your tendons pass through on the palm side of your fingers. When trigger finger occurs, the tendon has difficulty passing through the tunnels either due to thickening of a tunnel, inflammation of the tendon or both. This can result in a nodule that you may be able to feel most commonly at the base of your finger. This makes it difficult for the tendon to slide under the tunnel (pulley), causing a popping or clicking when straightening and bending the finger/thumb.

Causes:

The exact cause of trigger finger or thumb is not clear. Triggering occasionally appears after trauma to the hand. People with insulin dependent diabetes or who have rheumatoid arthritis, may be more prone to the condition.

Symptoms:

Clicking or catching of the finger when you try to bend and straighten it.

Treatment:

• Modifying your activity to rest your finger/thumb may settle the inflammation.
 • Try to avoid excessive gripping and pressure in the hand over the nodule area.
 • A splint to keep your knuckle in a straight position can help rest the tendon.

If your symptoms fail to settle, steroid injections can be an effective way to treat trigger finger. Surgery can also be considered if all other methods have failed.

Exercises:

People progress with the exercises at different rates and the exercises below are a guide. Repeat 5-10 times, 3-4 times a day.

https://static.wixstatic.com/media/e7d8af_d75ff5d20e884364b52496d949c9c156~mv2.png
Place your affected hand on a table with your palm up.
Bend the tip of the finger up in isolation. Do the movement slowly, you may feel a stretch but it should not be painful.
Fully straighten your finger (thumb) back after each bend.

https://static.wixstatic.com/media/e7d8af_39a1005255c6408daa9f6c5db51984d1~mv2.png

Place your affected hand on a table with your palm up. 
Bend the middle joint of the finger. Do the movement slowly, you may feel a stretch

but it should not be painful.
Fully straighten your finger after each bend.

3. The exercises below should allow your tendon to glide without catching or locking. Start with your fingers straight then bend your fingers as in the photos shown.
                                                          
https://static.wixstatic.com/media/e7d8af_e91efe7afc7246aebeb2fc4d1d9f4986~mv2.png
https://static.wixstatic.com/media/e7d8af_82056002bc734904850fb804e2ab0094~mv2.png

https://static.wixstatic.com/media/e7d8af_1ac5d081d5ee4784ba3d0956ae07c0dc~mv2.png
https://static.wixstatic.com/media/e7d8af_31b0a142568f4db2ac80ce4e4a33e57c~mv2.png

Further Resources: 
https://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb (https://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb)

https://www.hand-therapy.co.uk/_userfiles/pages/files/triggerfinger_nhs_england_leaflet.pdf (https://www.hand-therapy.co.uk/_userfiles/pages/files/triggerfinger_nhs_england_leaflet.pdf)

Last reviewed Jan 2026. To be reviewed Jan 2027.

Question 8

Volar Plate Injury

Accepted Answer

What is a volar plate injury?

A volar plate injury occurs when the middle joint of the finger is bent backwards forcefully. The volar plate is a thick ligament on the palm side of the finger that links two bones together. Occasionally, a small piece of bone is pulled off at the top where the ligament attaches, which, is called an avulsion fracture; an x-ray will confirm if this has occurred.

Causes:

This injury results from an over-stretching the volar plate ligament, usually from a fall or if something has hit the finger with force.

Symptoms:

• Pain
 • Swelling
 • Bruising on the palmar side of the injured finger
 • Reduced movement
 • Long term thickening of the joint

Treatment:

• Your injured finger may be strapped to the finger next to it (buddy strapping). This is to protect the joint in the early stages and is normally worn between four to six weeks. 
 • It is recommended that you avoid heavy activities/sports during this period to prevent further strain on the ligament. 
 • To help control the swelling try to keep your hand elevated. 
 • An exercise program will help maintain and improve the movement in your finger.

Exercises:

Try to do the exercises below 3-4 times a day, 5-10 repetitions for each exercise. The suggested repetitions are a guide only. If you are unable to tolerate the pain, then reduce the repetitions or stop

Tendon gliding exercises:

https://static.wixstatic.com/media/e7d8af_13833603e50847d886183bed6d32c54f~mv2.png

https://static.wixstatic.com/media/e7d8af_4949ae3b7a434ca3b724aff0571febaf~mv2.png

https://static.wixstatic.com/media/e7d8af_eb8ae9d5e4fd478d9a0366531439f354~mv2.png

https://static.wixstatic.com/media/e7d8af_1f77df6188c3477590e674a1a6b12610~mv2.png

https://static.wixstatic.com/media/e7d8af_673559a8022e4fa5a60a3f379ef678ac~mv2.png

Blocked isolated exercises:

https://static.wixstatic.com/media/e7d8af_d465cd25a79c46b19021d494da58b533~mv2.png

Bend the tip of your finger up and block the middle joint.

Fully straighten your finger after each bend.

https://static.wixstatic.com/media/e7d8af_55c84480ee7f4afabf3fcd507ecd6926~mv2.png

Bend the middle joint of your finger up.

Fully straighten your finger after each bend.

Further resources:
https://www.bssh.ac.uk/patients/conditions/1021/volar_plate_injury (https://www.bssh.ac.uk/patients/conditions/1021/volar_plate_injury)

Last reviewed Jan 2026. To be reviewed Jan 2027.

Question 9

Tendon Gliding Exercises

Accepted Answer

Tendon Gliding:

Tendon gliding exercises are designed to improve finger movement and to prevent stiffness and pain.

Question 10

Carpal Tunnel Syndrome

Accepted Answer

What is Carpal Tunnel Syndrome ?

Carpal Tunnel Syndrome is a condition where the median nerve is compressed within a tunnel structure in the wrist.

Causes:

• Coming soon.

·Symptoms: 
 • Altered sensation in the thumb, index, middle and ring fingers in the palm side of the hand 
 • Pain

The symptoms can be worse at night or when completing certain activities which involve the wrist in a bent or extended position.

Treatment:

• Coming soon.

Exercises: 
 • Coming soon

Further Resources:
https://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome (https://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome)
 
https://www.nhs.uk/conditions/carpal-tunnel-syndrome/ (https://www.nhs.uk/conditions/carpal-tunnel-syndrome/)

Last reviewed Dec 2025. To be reviewed Dec 2026.

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