From the Guidelines
De Quervain's tenosynovitis should be treated with a combination of rest, immobilization, anti-inflammatory medications, and corticosteroid injections, with surgical intervention considered if conservative measures fail after 3-6 months. The initial treatment approach typically involves:
- Rest and immobilization with a thumb spica splint worn 24/7 for 4-6 weeks
- Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) 1
- Ice applied to the affected area for 15-20 minutes several times daily to reduce inflammation If these methods don't provide relief, corticosteroid injections into the tendon sheath (typically 1ml of 40mg/ml methylprednisolone mixed with 1ml of 1% lidocaine) may be administered, with up to two injections spaced 4-6 weeks apart 1. Physical therapy focusing on gentle stretching and strengthening exercises can help restore function once acute pain subsides. Ultrasound-guided injections can be useful in treating De Quervain's tenosynovitis, as they allow for accurate placement of the injection into the affected tendon sheath 1. For cases resistant to conservative treatment after 3-6 months, surgical release of the first dorsal compartment may be necessary, which involves releasing the tight compartment to allow the tendons to move freely.
From the Research
Treatment Options for De Quervain's Tenosynovitis
- De Quervain's tenosynovitis can be treated by splinting, local corticosteroid injection, and operation 2
- Corticosteroid injection is more effective than immobilization for De Quervain's tenosynovitis, and combining the two treatments provides additional benefit 3
- The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied, and found to be superior to thumb spica splinting 4
Nonoperative Measures
- Most cases of de Quervain tenosynovitis can be managed with nonoperative measures, and the mainstay of treatment is corticosteroid injection (CSI) 5
- The use of ultrasound may improve the accuracy of injections and can help to identify and localize injections to separate subcompartments 5
- Local intralesional steroid injections are effective in providing pain relief for De Quervain's tenosynovitis, with efficacy seen in 86.81% of patients 6
Surgical Intervention
- Surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief when nonoperative treatment is unsuccessful 5
- Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy, resulting in fewer injuries to underlying structures and a lower incidence of hypertrophic scarring compared with a transverse incision 5
- Endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury 5