What are the management options for De Quervain's (De Quervain's tenosynovitis) tenosynovitis?

From the Guidelines

Management of De Quervain's tenosynovitis should begin with conservative approaches, including rest, activity modification, and immobilization with a thumb spica splint, as these methods reduce inflammation and pain, and may promote tendon healing 1. The initial treatment plan should focus on reducing the repetitive strain on the affected tendons, and this can be achieved through relative rest and reduced activity, which prevents further damage and promotes healing and pain relief 1. Some key management options for De Quervain's tenosynovitis include:

• Rest and activity modification to reduce repetitive loading of the damaged tendon 1
• Immobilization with a thumb spica splint worn continuously for 2-6 weeks to reduce inflammation and pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) to manage pain and inflammation
• Corticosteroid injections into the first dorsal compartment, which provide significant relief in 50-80% of patients and may be repeated if symptoms recur 1
• Physical therapy focusing on gentle stretching exercises, strengthening, and ergonomic modifications to aid recovery For patients who fail conservative management after 3-6 months, surgical release of the first dorsal compartment is highly effective, with success rates exceeding 90% 1. It's essential to note that while surgery is an effective option, it should be reserved for patients who have failed conservative therapy, as most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months with outpatient treatment consisting of relative rest, icing, and eccentric strengthening exercises 1.

From the Research

Management 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
• Ultrasound-guided injections can improve the accuracy of injections and help identify separate subcompartments 4
• Physical modalities such as ultrasound therapy, low-level laser therapy, and phonophoresis can be used as conservative treatments 5
• Surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief when nonoperative treatment is unsuccessful 4
• Open release and endoscopic FDC release are surgical options, with the latter resulting in quicker symptom improvement and superior scar cosmesis 4
• Platelet-rich plasma injection and percutaneous needle tenotomy are alternative treatment options, although more research is needed to support their effectiveness 6

Treatment Outcomes

• Corticosteroid injections have been shown to provide significant improvement in short-term outcomes, including treatment response, perceived improvement, and severity of pain 2
• The beneficial effects of steroid injections can be sustained for up to 12 months 2
• Surgical release of the FDC can provide excellent symptom relief, with studies showing significant improvement in pain and functional disability 4

Special Considerations

• Pregnant or breastfeeding women can be treated with corticosteroid injections without contraindication, as studies have shown no adverse effects on the baby 3, 4
• The use of ultrasound guidance can improve the accuracy of injections and reduce the risk of complications 4
• The WALANT (wide-awake local anesthesia no tourniquet) technique can be used for surgical release of the FDC, providing cost savings and improved patient comfort 4