Medically reviewed guide · Last updated: 1 September 2026 · Reading time: approx. 11 min

Wrist Pain: Tenosynovitis, Carpal Tunnel or Thumb Base Arthritis?

The most common causes compared

The causes in detail

This article deliberately sticks to the wrist and the base of the thumb. Pain in several joints, symptoms that move from joint to joint, or joint pain with fever and exhaustion are covered in the overview article on joint pain. If numbness of the fingers at night is the main issue, the article on numb hands will help; the condition itself is described in the article on carpal tunnel syndrome.

Tenosynovitis on the thumb side (de Quervain's)

On the thumb side of the wrist, two thumb tendons run together through a narrow tendon compartment. If their tendon sheath is irritated and thickened (de Quervain's stenosing tenosynovitis), it hurts when gripping, lifting, wringing and moving the thumb, often with slight swelling over the bony prominence on the thumb side. It frequently affects women, especially during pregnancy and in the months after giving birth — partly because the baby is lifted again and again with the thumb spread wide — and people who make a lot of repetitive gripping movements at work or in their hobbies.

First step: reduce the movement that triggers it and immobilise the thumb with a splint that includes the wrist. If that is not enough, a cortisone injection into the tendon sheath is considered effective; only rarely does the tendon compartment need to be opened surgically. The extensor tendons on the back of the hand can also become inflamed after unaccustomed strain, for example after renovating or gardening.

Rhizarthrosis: wear and tear at the base of the thumb

The thumb base joint (a saddle joint) connects the thumb to the wrist bones and is loaded with every pinch and grip. Its osteoarthritis (rhizarthrosis) is one of the most common forms of hand osteoarthritis and mainly affects women after the menopause. The pain is at the base of the thumb but is often felt as wrist pain: when opening jars, turning keys, writing or pinching. Later, strength and mobility decline, the base of the thumb thickens, and the thumb can become misaligned.

The first step is a thumb splint, joint protection in everyday life and occupational therapy; a cortisone injection can bring temporary relief. With severe symptoms, surgery may be an option, such as removing a small wrist bone (trapeziectomy) or a joint replacement.

Carpal tunnel syndrome: when the nerve joins in

In the carpal tunnel on the palm side of the wrist, the median nerve can become compressed. The key symptom is tingling and numbness at night in the thumb, index and middle fingers; pain can extend from the wrist into the forearm. Self-tests and other causes are covered in the article on numb hands linked above. The first step is a night splint, and the diagnosis is confirmed by nerve conduction studies.

Ganglion: the lump on the wrist

A ganglion (ganglion cyst) is an outpouching of the joint capsule or tendon sheath filled with jelly-like fluid, usually on the back of the hand and less often on the palm side near the pulse. It is firm and rubbery, often painless, but can cause a feeling of pressure. A ganglion is harmless and quite often goes away by itself. The formerly recommended practice of "smashing" it is advised against; after draining (aspiration) or surgery, it can come back. A hard swelling that cannot be moved or that grows quickly, on the other hand, should be seen by a doctor.

After a fall: radius, scaphoid and ligaments

The typical accident is a fall onto the outstretched hand. A fracture of the radius near the wrist is one of the most common fractures of all and particularly affects older women with osteoporosis — such a fracture after a simple fall is a reason to have your bone density checked. In younger people, sports accidents more often break the scaphoid, a small wrist bone on the thumb side: often little swelling, but tenderness in the hollow on the thumb side (the anatomical snuffbox). The fracture is not always visible on the first X-ray; if it is missed, it may heal poorly and lead to osteoarthritis later. Ligament injuries of the wrist are also easily overlooked.

Pain on the little-finger side

Between the ulna and the wrist bones lies a cartilage disc with ligament connections (TFCC, the "disc" of the wrist). It can tear in a fall or wear down over the years, especially if the ulna is slightly long in relation to the radius. Typical is pain on the little-finger side when rotating the forearm — door handle, screwdriver, wringing — and when leaning on the hand, sometimes with clicking. Tingling in the ring and little fingers in cyclists points more towards a trapped ulnar nerve at the wrist. First step: rest it, possibly a splint, and with persistent symptoms an examination by a hand surgeon, often with an MRI scan.

Inflammatory causes: rheumatoid arthritis, gout and pseudogout

In rheumatoid arthritis, the wrists are often among the first joints affected — usually on both sides, together with the knuckle joints and the middle joints of the fingers, with swelling and morning stiffness lasting more than half an hour. Early treatment is crucial, so a rheumatology assessment should take place within a few weeks. In older people, the wrist is a typical site for pseudogout, in which calcium crystals are deposited in the joint and suddenly cause a hot swelling. Classic gout affects the wrist less often. People with psoriasis can develop joint inflammation that also affects the wrist.

Less common: lunate necrosis and wrist osteoarthritis

In Kienböck's disease (lunatomalacia), the blood supply to the lunate, a central wrist bone, is disrupted. It mainly affects younger adults: pain in the middle of the back of the wrist, declining grip strength, and in the early stages visible only on MRI. Osteoarthritis of the wrist joint itself usually develops as a late consequence of old injuries. Pain that runs from the elbow into the forearm, on the other hand, is more likely to come from tendon attachments at the elbow, as in tennis elbow.

Self-tests: first clues at home

These tests do not replace a diagnosis and are sometimes mildly positive in healthy people too — always compare both sides. After a fall with severe swelling or deformity, there is no testing: the wrist needs an X-ray.

• The pain map: point with one finger to the most painful spot. The thumb side of the wrist, the base of the thumb, the palm side with tingling, the back of the hand with a lump, the little-finger side or the whole swollen joint? The location narrows down the causes considerably.
• The fist test (Finkelstein test): tuck your thumb into your palm, close your fingers over it and gently tilt your fist towards the little finger. A stabbing pain on the thumb side of the wrist suggests de Quervain's tenosynovitis.
• The grind test: hold your thumb near its base, press it gently towards the wrist and rotate it back and forth at the same time. Pain or grinding at the base of the thumb points to rhizarthrosis.
• The snuffbox press: spread your thumb out so that a small hollow forms on the thumb side of the wrist, and press into it. If the spot is clearly tender after a fall, the wrist should be X-rayed the same day — even if there is little swelling.
• The twist test: if it hurts on the little-finger side when you turn a door handle, wring out a towel or push yourself up on your hand to stand, the cartilage disc there is a possible candidate.
• The morning check: if both wrists or several finger joints are stiff and swollen for more than half an hour in the morning, that suggests an inflammatory cause — a case for a rheumatology assessment.

Warning signs: when not to wait

• A red, hot, very swollen wrist or a red, tense swelling along a tendon, especially with fever
• Increasing redness and swelling after an animal bite — cat bites in particular go deep —, a puncture wound or a splinter
• After a fall: deformity, severe swelling, you cannot put weight on the hand, or the anatomical snuffbox is clearly tender
• Under a cast or splint: increasing pain, numb, pale or bluish fingers
• Sudden weakness or numbness of the hand and arm, especially with a drooping corner of the mouth or difficulty speaking, and arm pain with chest tightness or shortness of breath
• Declining grip strength, a flattening ball of the thumb, or things falling out of your hand
• Several swollen joints with morning stiffness — have them checked promptly, within a few weeks

The treatment pathway: step by step

Without warning signs and without a recent accident, the assessment usually moves from the simple to the more elaborate.

1. Ease the load rather than immobilise. Reduce the activity that triggers it, vary your grip, and briefly cool the area if the irritation is recent. But a healthy wrist should not be completely immobilised for weeks.
2. Use a targeted splint. A thumb splint for de Quervain's tenosynovitis and rhizarthrosis, a night splint for carpal tunnel syndrome. General wrist supports off the shelf, on the other hand, often help little.
3. Have it examined at your GP or orthopaedic practice. Palpation, function tests, X-ray, ultrasound; if inflammation is suspected, blood tests such as inflammatory markers, uric acid and rheumatoid antibodies — and a look at your medication list.
4. Specialist care. Hand surgery for ligament and cartilage injuries, the scaphoid or a ganglion, rheumatology if inflammatory rheumatic disease is suspected, neurology for nerve conduction studies. MRI helps with ligament injuries and circulatory problems of the wrist bones.
5. Injection and therapy. A cortisone injection can bring relief in tenosynovitis and rhizarthrosis. Hand therapy and occupational therapy teach exercises and joint protection for everyday life.
6. Surgery if necessary. For example, opening the tendon compartment, widening the carpal tunnel, a procedure on the thumb base joint or treatment of a fracture. Whether and when to operate is always decided by the practice treating you, together with you.

The medication angle: when treatment gets to your wrist

Some active substances irritate tendons and joints directly, others raise uric acid levels or weaken the bones. If wrist pain begins without a clear reason, it is worth taking a look at your medication plan.

Fluoroquinolones: tendons under stress

Antibiotics from the fluoroquinolone group, such as ciprofloxacin or levofloxacin, can cause tendon inflammation and tendon rupture — most often in the Achilles tendon, but also in other tendons. The symptoms can start within the first few days or even months after taking them; older people, people with reduced kidney function and anyone taking cortisone at the same time are particularly at risk. For this reason, the BfArM (German Federal Institute for Drugs and Medical Devices) restricted their use in 2019. At the first sign of tendon pain: avoid strain and talk to your practice straight away.

Aromatase inhibitors: joints, tendon sheaths, carpal tunnel

Aromatase inhibitors such as anastrozole, letrozole or exemestane are often taken for many years after breast cancer. Joint pain and joint stiffness are among their most common side effects, especially in the hands and wrists; carpal tunnel syndrome and trigger finger are also listed in the summaries of product characteristics. Exercise and strength training can bring relief, and sometimes switching to another active substance helps. Do not stop the treatment on your own; talk to your oncology team instead.

Uric acid, bones and other candidates

Diuretics such as hydrochlorothiazide or furosemide, low-dose aspirin (acetylsalicylic acid) and ciclosporin can raise uric acid levels and encourage gout attacks. Long-term cortisone such as prednisolone weakens the bones and makes a fracture of the radius after a simple fall more likely; repeated cortisone injections into the same spot can weaken the skin and tendon. For diabetes medicines from the gliptin group, such as sitagliptin, joint pain has been described as a side effect that can go away after the medicine is stopped. Statins occasionally cause muscle problems and, rarely, tendon problems.

Painkillers: topical before systemic, limited duration

For osteoarthritis of the hand, European recommendations name anti-inflammatory gels such as diclofenac as the first choice of medicine, because they have far fewer side effects than tablets. Tablets such as ibuprofen or naproxen are intended for short periods: without medical advice, the package leaflet usually says no longer than three to four days in a row. Caution is needed if you take blood thinners or have weak kidneys or stomach problems; before an injection or surgery, your practice should know about your blood thinners. The painkiller comparison gives an overview; which treatment is right for you is always decided by the practice treating you.

How to prevent wrist pain

• Vary your grip, plan breaks — when using a keyboard, mouse or tools or doing handicrafts, keep your wrist as straight as possible, use thick handles and loosen up regularly.
• Lift your baby in a thumb-friendly way — support the baby with your whole hand and forearm instead of grasping it under the armpits with your thumbs spread wide.
• Protect your joints — with early rhizarthrosis, use aids such as jar openers or key turners; occupational therapy teaches joint-friendly techniques.
• Break your falls, strengthen your bones — wear wrist guards for inline skating or snowboarding, remove trip hazards as you get older, and have osteoporosis treated in good time.
• Keep your medication plan up to date — record courses of antibiotics, cortisone and long-term treatments such as aromatase inhibitors in it, so that a connection is spotted more quickly.

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