From the Research
The treatment for De Quervain's tenosynovitis typically begins with conservative measures, including rest, ice application, and immobilization with a thumb spica splint, followed by corticosteroid injections if necessary, as supported by the most recent and highest quality study 1.
Initial Treatment
Initial treatment includes:
- Rest
- Ice application to reduce inflammation
- Immobilization with a thumb spica splint worn continuously for 2-6 weeks to restrict movement of the affected tendons Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can help manage pain and reduce inflammation.
Corticosteroid Injections
If conservative measures don't provide relief, corticosteroid injections into the tendon sheath are often effective, with 1-2 injections of methylprednisolone (20-40mg) or triamcinolone (10-40mg) mixed with lidocaine providing relief in many cases, as shown in studies 2, 3, 4.
Physical and Occupational Therapy
Physical therapy focusing on gentle stretching and strengthening exercises for the wrist and thumb can be beneficial once acute pain subsides. Occupational therapy may help modify activities that aggravate the condition.
Surgical Release
For persistent cases not responding to conservative treatment after 4-6 months, surgical release of the first dorsal compartment may be necessary, with techniques such as the Ibri technique helping to avoid superficial radial nerve injury 5.
Long-term Management
This condition occurs when the tendons controlling thumb movement become inflamed as they pass through a narrow tunnel at the wrist, often due to repetitive hand movements, so addressing the underlying cause by modifying activities is essential for long-term management. A systematic review of physical modalities for conservative treatment found that laser therapy and therapeutic ultrasound were effective for De Quervain tenosynovitis 1.