From the Guidelines
De Quervain's syndrome is a painful condition affecting the tendons on the thumb side of the wrist, characterized by pain and swelling near the base of the thumb, especially when grasping or twisting, and is often caused by repetitive hand or wrist movements.
Diagnosis and Treatment
The condition can be diagnosed using ultrasound (US) to examine extra-articular soft tissues, such as suspected ganglion cysts, and to identify abnormalities of the flexor and extensor tendons and tendon sheaths 1.
- Treatment typically begins with conservative measures such as rest, ice, and anti-inflammatory medications like ibuprofen (400-800 mg three times daily).
- Wearing a splint to immobilize the thumb and wrist for 4-6 weeks can help reduce pain and inflammation.
- If these methods are ineffective, a corticosteroid injection into the tendon sheath may be recommended, and in severe cases that don't respond to conservative treatment, surgery to release the tendon sheath may be necessary.
Prevention and Recovery
Proper ergonomics and taking breaks during repetitive tasks are important for both prevention and recovery, as the condition is often caused by repetitive hand or wrist movements 1.
- Ultrasound (US) can be used to guide therapeutic intra-articular and other soft-tissue injections, and preoperative identification of a septum or subcompartmentalization within the first dorsal compartment with US may affect surgical management 1.
- The use of high-resolution US with or without arthrography for diagnosing intrinsic ligament has been tried, but its sensitivity in comparison with MRI, MR arthrography, and CT arthrography is unknown 1.
From the Research
Definition and Characteristics of De Quervain's Syndrome
- De Quervain's syndrome, also known as De Quervain's tendinopathy, is a musculoskeletal disorder that affects the region of the wrist and the hand, causing pain in thumb motion 2, 3.
- It is characterized by a degenerative process rather than inflammation, and primary treatment methods include splinting, non-steroid anti-inflammatory drugs, and physical therapeutic modalities 2.
- The condition involves a thickening of the extensor retinaculum, which covers the first dorsal compartment, and is often referred to as de Quervain's tenosynovitis 4.
Symptoms and Treatment Options
- Symptoms of De Quervain's syndrome include radial side wrist pain, particularly during lifting activities, and limited hand function 3, 4.
- Treatment options for De Quervain's syndrome include conservative management approaches such as:
- Splinting and oral non-steroidal anti-inflammatory drugs (NSAIDs) 5.
- Corticosteroid injections, which have been shown to be effective in relieving symptoms in 61-83% of cases 6.
- Physical therapy, including eccentric training, manual therapy, and exercise interventions 2, 3.
- Surgical release of the tendon sheath, which may be performed if conservative treatment options are unsuccessful 2, 4.
Effectiveness of Treatment Options
- Studies have shown that a multimodal approach using splint therapy and corticosteroid injections can be more beneficial than either treatment used in isolation 6.
- Eccentric training has been shown to improve pain intensity and hand function in patients with De Quervain's syndrome 2.
- Orthopedic manual physical therapy (OMPT) approaches, including first CMC manipulation, have also been shown to be effective in managing De Quervain's syndrome 3.