Rhizarthrosis vs De Quervain’s: How to Tell the Difference

What should I know about these conditions?

• Rhizarthrosis is arthritis at the base of the thumb. De Quervain’s is tendon inflammation on the thumb side of the wrist.
• Where the pain is tells you what it is. Pain deep in the joint means arthritis. Pain over the wrist tendons means de Quervain’s.
• Doctors use two tests: the Grind Test for arthritis and the Finkelstein Test for de Quervain’s.
• You can have both conditions at the same time, especially in women over 50.
• Treatments are very different, so the right diagnosis is important.

When your thumb hurts near the wrist, it can be hard to know what is wrong. The two common problems are rhizarthrosis (thumb arthritis) and de Quervain’s tenosynovitis (inflammation of the tendon sheath on the thumb side of the wrist). They hurt in similar places but are very different. Getting the right diagnosis is important because the treatments are not the same.

How are Rhizarthrosis and De Quervain’s different?

Here is a side by side comparison to help you understand the key differences:

What is rhizarthrosis

Rhizarthrosis: A Joint Problem

Rhizarthrosis is arthritis in the first carpometacarpal (CMC) joint. This is the saddle shaped joint where the thumb meets the hand bone. The cartilage lining this joint wears thin, which causes friction, inflammation, and sometimes bone on bone contact.

This condition grows slowly. People often notice more pain with pinching and gripping. Opening jars, turning keys, and writing become harder. The joint may enlarge and look squared off. Research shows that 25-33% of postmenopausal women have radiographic evidence of CMC arthritis, making it one of the most common forms of hand osteoarthritis.

For a complete overview, see our guide to thumb joint anatomy and our article on CMC arthritis stages.

De Quervain’s: A Tendon Problem

De Quervain’s tenosynovitis involves inflammation of two tendons that run through a tunnel on the thumb side of the wrist: the abductor pollicis longus and the extensor pollicis brevis. When the tunnel becomes irritated or thickened, the tendons cannot glide smoothly, causing pain with wrist and thumb movement.

This condition often starts suddenly. It is often linked to repetitive wrist movements, a new activity, or hormonal changes. It is common during pregnancy and the postpartum period. The pain tends to be sharper and more on the surface than the deep ache of arthritis.

What tests will my doctor use

The Grind Test

You doctor grasps your thumb and pushes it into the base while turning it in a circle. This squashes the CMC joint surfaces together. If this reproduces your deep pain and you feel a grinding or crunching, the test is positive for arthritis. The Grind Test has a sensitivity of about 42-53% and specificity of 80-93% for CMC arthritis, which means a positive test is fairly reliable, but a negative test does not rule it out.

The Finkelstein Test

You tuck your thumb inside a closed fist, then bend your wrist toward your little finger. This stretches the inflamed tendons in the first dorsal compartment. If this causes a sharp, sometimes intense pain over the thumb side of the wrist, the test is positive for de Quervain’s. This test is very sensitive, it catches most cases, but can occasionally be positive in other conditions too.

Can you have both at the same time

Yes, and this is more common than many patients realize. Studies suggest that co existing CMC arthritis and de Quervain’s occurs in approximately 10-15% of patients presenting with thumb side wrist pain, particularly in women over 50. When both conditions are present, treatment needs to address each one.

Signs that both may be present:

• You have pain both deep in the thumb base (joint) and along the wrist tendons
• Both the Grind Test and Finkelstein Test are positive
• X rays show joint changes but your pain pattern does not match arthritis alone
• A cortisone injection into the CMC joint helps only partially

How are treatments different

For Rhizarthrosis

• Splinting: A CMC stabilizing thumb splint to protect the joint, see our splint guide
• Hand therapy: Strengthening the muscles around the joint to improve stability
• Cortisone injections: Into the CMC joint for 3-6 months of relief
• Surgery (if conservative treatment fails): Trapeziectomy or joint replacement, explore options in our surgical treatment guide

For De Quervain’s

• Rest and activity modification: Avoiding the triggering movements
• Thumb spica splint: Immobilizing the wrist and thumb to rest the tendons
• Anti inflammatory medications: NSAIDs to reduce tendon inflammation
• Cortisone injection: Into the tendon sheath (not the joint), effective in about 80% of cases
• Surgery (rare): Release of the first dorsal compartment if injections fail

When should I see my doctor

See a doctor or hand specialist if:

• Your thumb or wrist pain has persisted for more than 2-3 weeks
• Pain is interfering with your daily activities or work
• Over the counter treatments are not providing relief
• You are unsure which condition you have; an accurate diagnosis guides the right treatment

Getting the right diagnosis is especially important because the injection techniques are different (joint vs tendon sheath), and an injection in the wrong location will not help. A hand specialist can usually tell the two conditions apart with a careful exam and standard X-rays.

For more information on the diagnostic process, see our diagnosis and imaging guide, or start with our comprehensive start here page.

Medical disclaimer

This article was prepared by the Hand Health Medical Advisory Board for educational purposes only. It is based on current medical literature and clinical guidelines, but it does not replace professional medical advice. Every patient’s situation is unique. Please consult your doctor or hand specialist before making any decisions about your treatment. If you are experiencing severe or worsening symptoms, seek medical attention promptly.