From the Guidelines
For De Quervain's tenosynovitis, the recommended injection is a corticosteroid, typically methylprednisolone acetate (40 mg/mL) or triamcinolone acetonide (10-40 mg/mL), mixed with 1-2 mL of 1% lidocaine without epinephrine, delivered into the first dorsal compartment of the wrist. This treatment approach is based on the understanding that corticosteroids can reduce inflammation in the tendon sheath, thereby decreasing friction and allowing the tendons to glide more freely, which addresses the underlying pathophysiology of the condition 1. The injection technique involves identifying the first dorsal compartment by palpating the tendons as they cross the radial styloid, then inserting a 25-gauge needle at a shallow angle into the tendon sheath, not the tendons themselves, with proper placement confirmed when minimal resistance is felt during injection. Key considerations for this treatment include:
- Most patients require only one injection for symptom relief, though some may need a second injection after 2-3 weeks if symptoms persist.
- Following injection, patients should rest the wrist for 48 hours and may use ice for discomfort.
- It is crucial to note that while corticosteroids may provide acute relief, they do not alter long-term outcomes, and their use should be balanced with potential risks, such as deleterious effects on the tendon when injected into the tendon substance 1. Given the current evidence, corticosteroid injections are considered effective for short-term pain relief in De Quervain's tenosynovitis, despite the lack of clear recommendations for their long-term use or optimal administration protocols 1.
From the FDA Drug Label
In treating acute nonspecific tenosynovitis, care should be taken to ensure that the injection of the corticosteroid is made into the tendon sheath rather than the tendon substance. The recommended injection for DeQuervain's tenosynovitis is into the tendon sheath.
- The dose is not specified for DeQuervain's tenosynovitis, but for local injections, the initial dose is 2.5 mg to 5 mg for smaller areas. 2
From the Research
Treatment Options for DeQuervain's Tenosynovitis
- DeQuervain's tenosynovitis can be treated with various methods, including corticosteroid injections, splinting, and surgery 3, 4, 5, 6, 7
Efficacy of Corticosteroid Injections
- Corticosteroid injections have been shown to be effective in treating DeQuervain's tenosynovitis, with a cure rate of 83% 6
- A study found that 73.4% of patients experienced treatment success within 2 injections, and 51.8% experienced success after 1 injection 5
- Another study demonstrated that local intralesional steroid injections were effective in providing pain relief for DeQuervain's tenosynovitis in 86.81% of patients 7
Comparison of Treatment Options
- Corticosteroid injections have been compared to other treatment options, such as splinting and surgery, and have been found to be a useful treatment for DeQuervain's tenosynovitis 3, 5, 6
- A study found that injection alone was the best therapeutic approach to DeQuervain's tenosynovitis, with a higher cure rate than other treatment options 6
Patient Characteristics and Treatment Outcome
- Patient characteristics, such as body mass index (BMI) and sex, have been found to be associated with treatment outcome, with female sex and BMI >30 being associated with increased treatment failure 5