# Tendon and overuse pain Tendon and overuse pain at the wrist and hand comes from repeated gripping, pinching and typing that loads a tendon, or the nerve at the wrist, faster than it recovers. Long bike descents, trades work, climbing and lifting a new baby are common causes here. We find what is overloaded, ease the load without stopping everything, and build it back up with graded loading, splinting and setup changes. ## Symptoms - Pain on the thumb side of the wrist when you grip, lift or twist - A sore spot over the wrist tendons that builds through a shift or ride - A finger or thumb that catches, clicks or locks as you straighten it - A tender lump in the palm at the base of a finger - Numbness or tingling in the thumb and first fingers, worse at night - A grip that fades by the end of a ride or a shift - Swelling along a tendon on the back of the wrist ## Assessment 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. ## Treatment 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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/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. ## Getting back to sport 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. ## When to come in 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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Hand Therapy](https://backinactionphysiotherapy.com/services/hand-therapy) - [Splints and Bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### What is De Quervain's? A tendon problem. Two tendons that lift the thumb out and up run through a tight tunnel on the thumb side of the wrist. Repeated pinching and lifting with the wrist bent sideways irritate them. The wrist then hurts when you grip, make a fist around the thumb, or lift a pan, a baby or a bike. We treat it with a thumb and wrist splint, graded loading, and changes to how you lift. ### Why does my finger catch or lock? Trigger finger, usually. The tendon that bends the finger runs through a row of loops (pulleys) in the palm. If the tendon or its lining thickens, it catches as it passes the first loop near the base of the finger. The finger then sticks bent and snaps straight. A small splint that keeps the finger straight at night, and a break from hard gripping, often settle it. If it stays locked, a doctor or nurse practitioner can talk through an injection or a small operation. ### Is numbness in my hand at night carpal tunnel? Often, yes. Pins and needles in the thumb, index and middle fingers that wake you point to the nerve at the wrist (the median nerve, carpal tunnel syndrome). Shaking the hand out often eases them for a while. By day it may show as clumsy fingers, or a hand that goes numb on the bars or holding a phone. Numbness in the little finger, or across the whole hand, points elsewhere, and we test for that. A night splint is usually the first step. ### Will a wrist brace fix it on its own? Not by itself. A brace or splint rests the tendon or the nerve, mostly at night and during the tasks that flare it, so the pain can settle. The strength comes from the loading exercises, and the setup changes help keep it from coming back. Wear it for the hours we set out, and wean off it as the exercises take over. A wrist held still all day gets stiff and weak, which is the opposite of what you need. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*