From the Guidelines
De Quervain's tenosynovitis, a condition characterized by painful nodules on the thumb side of the wrist, can be effectively diagnosed and managed using ultrasound (US) to examine extra-articular soft tissues and guide therapeutic injections, as supported by the American College of Radiology 1. De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist.
Key Points
- Treatment typically begins with conservative measures including rest, ice, and anti-inflammatory medications.
- Wearing a thumb spica splint that immobilizes the thumb and wrist for 2-6 weeks is highly effective.
- For persistent symptoms, a corticosteroid injection into the tendon sheath provides relief in about 80% of cases.
- Physical therapy focusing on gentle stretching and strengthening exercises helps prevent recurrence.
- Surgery is reserved for cases that don't respond to conservative treatment after 4-6 months.
Diagnosis and Management
The use of US in diagnosing De Quervain's disease is beneficial, as it can identify a septum or subcompartmentalization within the first dorsal compartment, which may affect surgical management 1. US can also be used to guide therapeutic intra-articular and other soft-tissue injections 1. This condition occurs when the two tendons that control thumb movement become inflamed as they pass through a narrow tunnel in the wrist, causing pain with thumb and wrist movements, especially when gripping or twisting. Avoiding repetitive hand and wrist movements during recovery is essential for healing. Ultrasound is a useful technique for examining extra-articular soft tissues, such as suspected ganglion cysts, and its accuracy is similar to that of MRI 1.
From the Research
De Quervain's Tenosynovitis
- De Quervain's tenosynovitis is a condition characterized by pain and tenderness over the first extensor compartment of the wrist, containing the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons 2.
- The condition is more common in women, particularly aged 30-50 years old and those 4-6 weeks in their post-partum period 2.
- De Quervain's tenosynovitis can be associated with trauma or repetitive motion but is typically of unknown etiology 2.
Treatment Options
- Non-operative treatment options include anti-inflammatory medication, wrist splints, and local steroid injection 2, 3.
- Operative treatment options include surgical release of the 1st dorsal compartment 2, 4.
- Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections 5.
- Eccentric training can be an alternative to current treatment options, with significant improvements in pain intensity and hand and wrist functionality 3.
Patient Characteristics and Treatment Outcome
- Female sex and BMI >30 are associated with increased treatment failure 5.
- African American race, hypothyroidism, and carpal tunnel syndrome may also be associated with increased odds of treatment failure, although not reaching statistical significance 5.
- Corticosteroid injections can provide optimal symptomatic relief to pregnant or breastfeeding women without impacting the baby 4.