Signs and symptoms

  • Pain radiating from the thumb to the first extensor compartment on radial side of the wrist.
  • Pain is aggravate by lifting the thumb, as in the hitchhiker position or a combination of grip and twist activities.
  • Tenderness on palpation
  • Swelling over radial compartment of extensor retinaculum – compare it with same spot on the opposite wrist.
  • Crepitus on movement
  • Positive Finklesteins test

Advice in Primary Care

  • Immobilise in wrist thumb splint for 2 weeks
  • Ice every couple of hours
  • Anti-inflammatory medication
  • Activity modification – avoid repetitive grip/twist activities, allow for periods of rest, reduce all aggravating factors, reduce grip strain e.g. padded grips on utensils , pens , knives etc

Actions in Primary Care

  • Follow conservative management advice and provide patient with attached information (this includes advice re purchasing the appropriate splints)
  • If initial conservative advice fails to settle symptoms consider steroid injection by appropriately trained Healthcare practitioner (less successful in Diabetic Patients).
  • If symptoms persist local injections can be repeated once more only. 
  • If this skill is not available in surgery refer into OT Hand clinic

Patient advice leaflet

Referral to Secondary Care

  • If symptoms persist following 6-8 weeks of self management

Refer via SCI Gateway to Occupational Therapy Hand Clinic and include following in referral:

  • Occupation
  • Duration of; Symptoms, Self management
  • Precipitating factors i.e. injury/trauma, occupation
  • Provocative testing (Finkelsteins)

Editorial Information

Last reviewed: 23/01/2024

Next review date: 23/01/2026

Version: 1

Reviewer name(s): Jan Beaumont.