From the Guidelines
Treatment for De Quervain's tenosynovitis should begin with conservative measures, including rest, immobilization, and non-steroidal anti-inflammatory drugs (NSAIDs), as these methods have been shown to be effective in reducing pain and inflammation 1.
Conservative Treatment Options
- Rest and immobilization with a thumb spica splint worn 24 hours a day for 4-6 weeks to reduce strain on the affected tendons
- NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), to reduce pain and inflammation
- Ice applied to the affected area for 15-20 minutes several times daily to reduce swelling and pain
Additional Treatment Options
- Corticosteroid injections into the tendon sheath, with 1-2 injections of methylprednisolone or triamcinolone mixed with lidocaine, providing relief in up to 80% of patients
- Physical therapy focusing on gentle stretching and strengthening exercises to maintain mobility and prevent recurrence
- Activity modification to avoid repetitive thumb and wrist movements during recovery
Surgical Options
- Surgical release of the first dorsal compartment may be necessary for cases resistant to conservative treatment after 3-6 months 1. It is essential to note that while the provided study 1 discusses various tendon problems, the principles of treatment, including rest, NSAIDs, and physical therapy, can be applied to De Quervain's tenosynovitis, prioritizing morbidity, mortality, and quality of life as outcomes.
From the Research
Treatment Options for De Quervain's Tenosynovitis
- Nonoperative measures are the mainstay of treatment, with corticosteroid injection (CSI) being the primary treatment option 2, 3, 4
- The use of ultrasound may improve the accuracy of injections and help identify and localize injections to separate subcompartments 2
- For patients who are in the third trimester of pregnancy or breastfeeding, there is no contraindication to CSI, as studies have shown that it can provide optimal symptomatic relief to the mother without impacting the baby 2
Surgical Treatment Options
- When nonoperative treatment is unsuccessful, surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief 2
- Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy, resulting in fewer injuries to underlying structures and a lower incidence of hypertrophic scarring compared with a transverse incision 2
- Endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury, for surgeons who are comfortable performing endoscopic techniques 2
Effectiveness of Treatment Options
- Corticosteroid injections have been shown to be effective in treating De Quervain's tenosynovitis, with a treatment success rate of 73.4% within 2 injections 3
- Extracorporeal shockwave therapy has been shown to be effective in the short-term and medium-term, and may be considered a secondary option to CSI 5
- Combining CSI with orthosis or immobilization may provide additional benefit and greater efficacy than CSI alone or immobilization alone 5, 4
Patient Characteristics and Treatment Outcome
- Female sex and BMI >30 have been found to be significantly associated with treatment failure, with a 2.4-fold increase and 3.23 times greater odds of failure, respectively 3
- Other factors, such as African American race, hypothyroidism, and carpal tunnel syndrome, may also be associated with increased odds of treatment failure, although not reaching statistical significance 3