From the Guidelines
Conservative management of de Quervain's tenosynovitis should prioritize relative rest, cryotherapy, and eccentric strengthening exercises to promote healing and pain relief, as supported by the American Family Physician guidelines 1. The first-line approach typically involves resting the affected thumb and wrist, avoiding activities that aggravate symptoms, and using a thumb spica splint for 3-6 weeks to immobilize the first dorsal compartment while allowing finger movement.
- Relative rest and reduced activity prevent further damage and promote healing and pain relief, as recommended by the American Family Physician guidelines 1.
- Cryotherapy, such as repeated applications of melting ice water through a wet towel for 10-minute periods, provides acute relief of tendinopathy pain and its use is widely accepted 1.
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, as supported by the American Family Physician guidelines 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can help reduce pain and inflammation, but have no effect on long-term outcomes 1.
- Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes, as noted in the American Family Physician guidelines 1. Physical therapy focusing on gentle stretching exercises and strengthening of the wrist and thumb can be initiated once acute pain subsides.
- Ergonomic modifications to reduce repetitive thumb movements are also beneficial in preventing further injury and promoting recovery 1. These conservative measures are effective for most patients because they reduce inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment, allowing the tendons to glide more freely and reducing pain during thumb and wrist movement.
From the Research
Conservative Management Options
The conservative management of De Quervain's tenosynovitis includes various treatment approaches. Some of the options are:
- Ultrasound therapy 2
- Low level laser therapy 2
- Phonoporesis 2
- Anodyne therapy 2
- Corticosteroid injections 3, 4
- Immobilization with a thumb spica splint 5, 3, 4
- Occupational therapy with tendon gliding exercises 5
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 5
- Soft tissue and myofascial release therapy 6
- Tool assisted fascial stripping or "guasha" 6
- Acupuncture 6
- Mobilizations and kinesiology taping 6
- Home advice including icing, rest, wrist bracing, elevation, and eccentric rehabilitation exercises 6
Effectiveness of Conservative Management
Studies have shown that conservative management can be effective in treating De Quervain's tenosynovitis. For example, a case study found that a combination of ultrasound, soft tissue therapy, and home exercises resulted in complete resolution of symptoms 6. Another study found that corticosteroid injections with or without immobilization resulted in significant improvement in symptoms and function 3. A systematic review found that laser therapy and therapeutic ultrasound were the most used and effective physical therapies for De Quervain tenosynovitis 2.
Special Considerations
In some cases, special considerations may be necessary. For example, patients with lymphedema may require modified treatment approaches to avoid complications such as infection 5. Additionally, patients with De Quervain's tenosynovitis may need to avoid activities that aggravate the condition, such as repetitive wrist movements or heavy lifting 6, 4.