What is the treatment for De Quervain's tenosynovitis or a simple sprain?

Treatment of De Quervain's Tenosynovitis and Simple Sprains

For De Quervain's tenosynovitis, corticosteroid injection alone is the most effective first-line treatment, providing significant symptom relief without the need for immobilization. 1

De Quervain's Tenosynovitis Treatment Algorithm

First-Line Treatment

• Corticosteroid Injection
  • Inject 1ml of triamcinolonacetonide (10mg/ml) or methylprednisolone acetate (40mg) with 1cc lidocaine 2% into the first dorsal compartment at the area of maximal tenderness 1, 2
  • Success rate of approximately 78% with a single injection 2
  • Up to 58% of patients may achieve complete resolution with a single injection, while another 33% may require multiple injections 3
  • Number needed to treat is 2 (95% CI: 1,3) 2

Adjunctive Treatments

• NSAIDs for Pain Management

  • Options include naproxen 500mg twice daily or ibuprofen 1.2-2.4g daily 4
  • Can be combined with paracetamol (up to 4g daily) for enhanced pain relief 4

• Rehabilitation Program

  • Eccentric strengthening exercises focusing on the affected tendons 4
  • Functional support with a thumb spica brace may be considered, though evidence suggests immobilization after injection does not improve outcomes 1

Second-Line Treatment (for non-responders after 3-6 months)

• Physical Modalities

  • Low-level laser therapy and therapeutic ultrasound have shown some efficacy 5
  • Consider these options for patients who cannot receive or do not respond to corticosteroid injections

• Surgical Intervention

  • Consider if conservative measures fail after 3-6 months of well-managed treatment 4
  • Surgical release of the first dorsal compartment

Simple Sprain Treatment Algorithm

Acute Phase (0-4 weeks)

• Pain Control

  • NSAIDs: Naproxen 500mg twice daily or ibuprofen 1.2-2.4g daily 4
  • Ice application for 15-20 minutes every 2-3 hours during the first 48-72 hours

• Protected Range of Motion

  • Avoid immobilization as it can lead to stiffness and delayed recovery 4
  • Early, gentle range of motion exercises within pain-free limits

Intermediate Phase (4-8 weeks)

• Progressive Strengthening
  • Eccentric strengthening exercises targeting the affected area 4
  • Gradual increase in resistance and repetitions

Advanced Phase (8-12 weeks)

• Functional Training
  • Occupation-specific and functional exercises 4
  • Gradual return to pre-injury activities

Important Clinical Considerations

Effectiveness of Treatments

• Corticosteroid injections for De Quervain's tenosynovitis show both short-term and long-term benefits, with sustained improvement in pain and function at 12-month follow-up 2
• Adding thumb spica casting after corticosteroid injection may increase treatment success rate (93% vs 69% with injection alone) according to some studies 6, but more recent evidence suggests immobilization does not improve outcomes and may hinder daily activities 1

Monitoring and Follow-up

• Regular assessment at 2,6, and 12 weeks to evaluate pain levels, range of motion, and functional improvement 4
• If no improvement occurs after 6-8 weeks of conservative treatment, consider specialist referral 4

Cautions and Limitations

• Limit corticosteroid injections to 2-3 injections, with 4-6 weeks between injections 4
• Monitor for potential adverse effects of corticosteroid injections, though these are typically minor and self-limited 3
• Return to full activity should only be permitted when the patient demonstrates complete resolution of pain, full range of motion, and strength symmetry >90% compared to the uninjured side 4

Return to Activity Criteria

• Complete resolution of pain
• Full range of motion
• Strength symmetry >90% compared to uninjured side
• Successful completion of occupation-specific functional tests 4