From the Guidelines
De Quervain's tenosynovitis is a condition that affects the tendons on the thumb side of the wrist, causing pain and tenderness, specifically stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendon compartment 1.
Key Characteristics
- The condition is characterized by pain and tenderness on the thumb side of the wrist, which can be exacerbated by activities that involve repetitive thumb motion.
- US examination can be useful in diagnosing De Quervain's disease, particularly in identifying a septum or subcompartmentalization within the first dorsal compartment, which may affect surgical management 1.
Treatment Options
- Conservative treatment is recommended as the initial approach, which may include immobilizing the wrist and thumb with a splint, using anti-inflammatory medications such as ibuprofen or naproxen, and administering corticosteroid injections into the affected tendon sheath 1.
- Surgical release of the tendon sheath may be necessary in severe cases or if conservative treatment fails, which can be an effective treatment option in carefully selected patients 1.
Important Considerations
- It is essential to consult a healthcare professional for proper diagnosis and treatment, as De Quervain's tenosynovitis can be misdiagnosed or mistreated if not properly evaluated 1.
- US-guided injections can be a useful technique to guide therapeutic intra-articular and other soft-tissue injections, which may be beneficial in managing De Quervain's tenosynovitis 1.
From the Research
Definition and Characteristics
- De Quervain's tenosynovitis is a condition characterized by pain and tenderness over the first extensor compartment of the wrist, which contains the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons 2, 3.
- It is a tendon sheath inflammation of the musculus abductor pollicis longus (APL) and the musculus extensor pollicis brevis (EPB) in the first extensor compartment of the wrist 4.
- The condition is often associated with repetitive motion, trauma, or unknown etiology, and is more common in women, particularly those aged 30-50 years old and those in their post-partum period 3.
Symptoms and Diagnosis
- Patients typically present with pain symptoms on the radial side of the wrist, resulting from repetitive movements and consequent overload of the tendons 4.
- Clinical evaluation is usually required for diagnosis, although imaging studies may be used to confirm the diagnosis or rule out alternative diseases 2.
- The condition can be easily distinguishable from other wrist injuries during physical examination 4.
Treatment Options
- Treatment options include non-operative methods such as anti-inflammatory medication, wrist splints, and local steroid injection, as well as operative treatment like surgical release of the 1st dorsal compartment 3.
- A multimodal approach with conservative management is often the most effective treatment, with surgical intervention usually not necessary 4.
- Conservative treatment complemented by eccentric training may provide an adequate alternative to currently accepted treatment options, with significant improvements in pain intensity and hand and wrist functionality 5.
- Applying ice to the affected area, using a splint, and taking nonsteroidal anti-inflammatory medication (NSAIDs) can help ease the pain 2.