Massage therapy · Kitchener–WaterlooRepetitive Strain Injury to the Thumb

Repetitive strain injuries can affect your tendons, impair your ability to perform normal, everyday tasks and cause pain. The thumb is especially susceptible to these types of injuries. Activities requiring repeated thumb movements or using hand tools can end up leading to these injuries.

Tendons are rope-like structures that attach muscles to bones, allowing the bones to move (OrthoInfo, n.d.). To move the thumb, the tendons need to glide through slippery tunnels known as sheaths. A repetitive strain injury can cause the sheaths to become irritated and thickened. In De Quervain's tenosynovitis, the tendons that move the thumb away from the hand and straighten it (into a hitch-hiking position) become irritated inside their tunnel, often through overuse (OrthoInfo, n.d.; University Hospitals Plymouth NHS Trust, 2023). Pain usually occurs on the thumb side of the wrist and can travel up into the forearm (OrthoInfo, n.d.).

Causes of RSI of the Thumb

The most common causes of RSI of the thumb are

• Keyboard typing, especially with a poor typing position (OrthoInfo, n.d.; NHS, 2026)
• "Text thumb" – repeated texting on your phone (OrthoInfo, n.d.)
• Lifting, for example lifting a child, with your thumbs pointing upwards (OrthoInfo, n.d.)
• Jobs or hobbies that involve a lot of repetitive gripping, pinching or wringing movements (University Hospitals Plymouth NHS Trust, 2023)
• Using hand-held power tools regularly (NHS, 2026)

How to Treat a Repetitive Strain Injury to the Thumb

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Avoid using hand tools for long periods without stopping to give your hand a break, as a lack of rest breaks can contribute to these injuries (HSE, n.d.).
• Do not rest the thumb completely for more than a few days, as resting for too long can make it weaker and less flexible. Keep active, limiting what you do at first and then gradually increasing it (NHS, 2026).
• When you repeatedly use your thumb you are opening it up to repetitive strain injuries from the wear-and-tear placed on the tendons.
• When playing sports, make sure your wrist and thumb are protected from potential injury.
• Take regular breaks if you start to get thumb pain, as you are probably over-using your thumb tendons.
• Perform the thumb strengthening exercises I give you.
• See your family doctor or nurse practitioner if your symptoms are not going away or are getting worse (NHS, 2026).

Thumb and wrist tendon pain usually builds up from doing the same grip or movement many times a day. My aim is to settle the irritated tendons, keep your thumb and wrist moving, and then build their tolerance back up while we change whatever overloaded them.

I start by asking about your work, hobbies and phone and keyboard use. Then I assess how your thumb, wrist and forearm move, test their strength, and use simple tests to see which tendons are irritated. If you have tingling or numbness, I also check your neck and screen your nerves (sensation, reflexes and strength).

When It's Sore

• I leave the sore spot itself alone and work the forearm, upper arm and shoulder to ease tension pulling on the tendons
• Gentle, pain-free movement of the thumb and wrist so they don't stiffen
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Cutting back the movements that flare it, rather than stopping everything
• Help choosing a splint and how long to wear it, and taping for support, which I'll show you how to do yourself

As It Settles

• Myofascial work and muscle stripping through the forearm and, once the tendons are no longer acutely sore, cross-fibre work on tight, stuck-down spots, followed by a gentle stretch
• Self-massage and contrast bathing (alternating warm and cool water) to use at home
• Pain-free strengthening for the thumb, wrist and grip, from gentle holds to slow lowering exercises, with a home programme between visits

Changing the Cause

1. American Academy of Orthopaedic Surgeons (OrthoInfo) (n.d.) De Quervain's Tenosynovitis. Available at: https://www.orthoinfo.org/en/diseases--conditions/de-quervains-tendinosis/ (Accessed: 7 October 2026).
2. University Hospitals Plymouth NHS Trust (2023) DeQuervain's Tenosynovitis. Available at: https://www.plymouthhospitals.nhs.uk/display-pil/pil-dequervains-tenosynovitis-6904 (Accessed: 7 October 2026).
3. NHS (2026) Repetitive strain injury (RSI). Available at: https://www.nhs.uk/conditions/repetitive-strain-injury-rsi/ (Accessed: 7 October 2026).
4. Health and Safety Executive (n.d.) Upper limb disorders. Available at: https://www.hse.gov.uk/msd/uld/index.htm (Accessed: 7 October 2026).