What is the treatment for De Quervain's tenosynovitis?

Treatment of De Quervain's Tenosynovitis

The most effective treatment for De Quervain's tenosynovitis is a multimodal conservative approach, with corticosteroid injections showing approximately 90% success rate either with a single injection (58%) or multiple injections (33%). 1

First-Line Conservative Management

1. Pain Management and Anti-inflammatory Therapy

   • NSAIDs are strongly recommended as first-line treatment
     • Ibuprofen 1.2g daily (safest option)
     • Can be increased to 2.4g daily if needed
     • May be combined with acetaminophen (up to 4g daily) for inadequate relief 2

2. Immobilization

   • Thumb spica splinting to restrict movement of the affected tendons 3
   • Wear during activities that aggravate symptoms and at night

3. Corticosteroid Injections

   • Highly effective treatment with approximately 90% success rate 1
   • Methylprednisolone acetate injection into the first dorsal compartment
   • Limited to 2-3 injections with 4-6 weeks between injections 2
   • Most effective in the acute phase of the condition 4

4. Physical Modalities

   • Laser therapy and therapeutic ultrasound have shown effectiveness 5
   • RICE protocol (rest, ice, compression, elevation) for initial pain management 2

Rehabilitation Program

Follow a phased approach to rehabilitation:

Phase	Focus	Duration
Initial	Pain control and protected range of motion	0-4 weeks
Intermediate	Progressive strengthening exercises	4-8 weeks
Advanced	Occupation-specific training	8-12 weeks

• Manual therapy of the lower quadrant 2
• Exercise therapy focusing on:
  • Gentle stretching exercises for the affected tendons
  • Strengthening exercises for wrist and thumb
  • Activity modification to avoid aggravating movements 6

Surgical Intervention

Surgical release of the first dorsal compartment should be considered when:

• Pain persists despite 3-6 months of well-managed conservative treatment
• Functional limitations significantly impact quality of life 2, 6

During surgery, care must be taken to:

• Protect the radial sensory nerve
• Identify all accessory compartments
• Repair of the extensor retinaculum is rarely required 3

Return to Activity Criteria

Return to full activity is permitted when the patient demonstrates:

• Complete resolution of pain during and after activity
• Full range of motion compared to uninjured side
• Strength symmetry >90% compared to uninjured side 2

Important Considerations

• Early recognition and treatment is crucial for better outcomes, especially in the acute phase 4
• De Quervain's tenosynovitis typically presents with pain on the radial side of the wrist due to repetitive movements 4
• Women are more commonly affected than men 3
• Radiographs may be helpful to rule out bony pathology 3
• Adverse reactions to corticosteroid injections are typically self-limited and minor, with no reported tendon ruptures or local infections in studies 1