From the Guidelines
De Quervain's tenosynovitis is primarily treated with conservative measures, including rest, immobilization, anti-inflammatory medications, and corticosteroid injections, with surgical intervention considered for cases resistant to conservative treatment. The treatment approach is multifaceted, aiming to reduce inflammation, relieve pain, and restore function. Initial management involves:
- Rest and immobilization with a thumb spica splint worn continuously for 2-6 weeks
- Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) 1
- Ice application for 15-20 minutes several times daily to reduce inflammation
- Corticosteroid injections, typically containing 10-25mg of methylprednisolone or equivalent mixed with local anesthetic, which are highly effective and may provide long-term relief in 50-80% of patients after 1-2 injections
The use of ultrasound (US) in the diagnosis and treatment of De Quervain's tenosynovitis is notable, as it can help identify abnormalities of the flexor and extensor tendons and tendon sheaths, including the presence of a septum or subcompartmentalization within the first dorsal compartment, which may affect surgical management 1. US can also guide therapeutic intra-articular and other soft-tissue injections, making it a valuable tool in the treatment of this condition.
For cases that do not respond to conservative treatment after 4-6 months, surgical release of the first dorsal compartment is considered, which has a high success rate exceeding 90%. It is essential for patients to avoid aggravating activities, such as gripping, pinching, or twisting motions, and make ergonomic modifications to work and daily tasks to facilitate recovery. Physical therapy focusing on gentle stretching and strengthening exercises can help maintain mobility and prevent recurrence once acute symptoms subside.
From the FDA Drug Label
In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg In recurrent or chronic conditions, repeated injections may be necessary.
Treatment of De Quervain's tenosynovitis involves injecting the suspension into the tendon sheath. The dose ranges from 4 to 30 mg, and repeated injections may be necessary for recurrent or chronic conditions 2.
From the Research
Treatment Options for De Quervain's Tenosynovitis
- De Quervain's tenosynovitis can be treated with conservative methods, including corticosteroid injections and supportive thumb spica splinting 3, 4
- A study found that thumb spica casting along with local corticosteroid injection is superior to casting alone for treating De Quervain's tenosynovitis, leading to significantly better pain relief and functional outcomes 5
- Surgical release of the first dorsal compartment is done in resistant cases, taking care to protect the radial sensory nerve and identify all accessory compartments 6, 3
Conservative Treatment Methods
- Corticosteroid injections have been found to be effective in treating De Quervain's tenosynovitis, with one study showing that all patients in the steroid injection group achieved complete relief of pain 4
- Physical modalities such as ultrasound therapy, low level laser therapy, and phonoporesis have also been studied as conservative treatment options for De Quervain's tenosynovitis 7
- Laser therapy and therapeutic ultrasound were found to be the most used and effective physical therapies for De Quervain tenosynovitis 7
Surgical Treatment Methods
- Surgical release of the first dorsal compartment is a treatment option for De Quervain's tenosynovitis, with techniques evolving to avoid damage to the superficial branch of the radial nerve (SBRN) 6
- A technique using a specific incision method has been described to avoid SBRN injury, with no incidence of damage to the SBRN reported in 17 operated wrists 6