Tendon and overuse pain

We begin with the load: what your hands do all day, and what changed. We press along the thumb-side tendons (the ones De Quervain's affects), the back of the wrist, and the palm. We feel each tendon move as you grip, pinch and straighten your fingers, and whether one catches (trigger finger). We test the nerve at the wrist, and the feeling and strength in your hand, and check the neck, where tingling can start.

We also look at your setup: your bars, your tools, your desk and keyboard. If the findings point to a joint problem, or a nerve that is losing strength, we ask you to see a doctor or nurse practitioner.

Easing the load comes first, without stopping everything. A sore tendon needs a smaller dose of what flares it, not complete rest. That might mean lighter tools, shorter descents, breaks from the keyboard, or lifting the baby with your forearms rather than your thumbs.

Treatment then matches what the assessment found:

• Graded loading: exercises that work the wrist and thumb tendons at a dose they can handle, building step by step. This is the main treatment, and the part that lasts.
• Splints and braces: a splint moulded to your hand from a plastic that softens with heat (thermoplastic) rests the thumb, wrist or finger while a tendon settles. A wrist brace takes the strain on the tools or the bike. See splints and bracing.
• Technique and setup: bar and lever angle so your wrists sit straighter, tool handles that fit your grip, keyboard height, and how you lift and carry.
• Hand therapy: rehab of the hand and wrist that draws on both physiotherapy and occupational therapy, through a Certified Hand Therapist, certified by the Hand Therapy Certification Commission. It suits a finger that locks, or a tendon that is slow to settle. See hand therapy.

Night-time numbness in the thumb and first fingers usually comes from the nerve at the wrist (carpal tunnel syndrome), not a tendon. A night splint keeps the wrist straight, nerve-gliding exercises keep it moving, and by day we change the grips and wrist positions that press on it.

Return to sport is by steps, and often starts before the pain has fully gone. You move up a step once the one you are on makes your pain no more than a little worse. There is no set date: the tendon sets the pace.

For riders, that means short laps with the wrists set straighter on the bars, then longer descents as the grip holds. Climbers build volume before intensity: time on the wall at an easy grade, then pinches and slopers once the thumb can take them.

The same steps cover work, study and sport, from lighter tools and shorter keyboard hours back to a full day.

Book an assessment if wrist or thumb pain is affecting your grip, your riding or your work. Come in too if a finger catches or locks, or if tingling wakes you at night. If it started at work, WorkSafeBC may cover the treatment once it accepts your claim.

Go to the emergency department right away, or call 911, if any of these happen:

• a finger or hand you cannot bend or straighten after an injury
• a hand or finger that is hot, red and swollen
• a deep cut to the hand or wrist