What is the treatment for De Quervain's tenosynovitis?

Treatment for De Quervain's Tenosynovitis

The treatment of De Quervain's tenosynovitis should follow a stepwise approach starting with conservative measures including thumb spica splinting, activity modification, and NSAIDs, progressing to corticosteroid injections if symptoms persist, and finally surgical release for refractory cases. 1

First-Line Management

Rest and Activity Modification

• Relative rest and activity modification are essential initial treatments to decrease repetitive loading of the damaged tendons 1
• Complete immobilization should be avoided to prevent muscle atrophy and deconditioning 2, 1
• Technique modification for athletes and manual laborers aims to minimize repetitive stresses placed on tendons 2

Splinting

• Thumb spica splint to immobilize the wrist and thumb is a recommended first-line treatment to reduce tension on affected tendons 1
• Splinting helps reinforce, unload, and protect tendons during activity 2

Cryotherapy

• Ice therapy applied through a wet towel for 10-minute periods can effectively reduce pain and inflammation 2, 1
• Cryotherapy works by slowing tissue metabolism and blunting the inflammatory response 2

Analgesics

• NSAIDs effectively relieve pain and may offer additional benefit in acute inflammatory cases 2, 1
• Topical NSAIDs can also reduce tendon pain while eliminating the increased risk of gastrointestinal side effects associated with oral NSAIDs 2

Second-Line Management

Corticosteroid Injections

• Locally injected corticosteroids provide significant pain relief in the acute phase and may be more effective than oral NSAIDs for immediate symptom control 2, 1
• Ultrasound-guided injections are recommended to ensure proper placement, especially given that multiple subcompartments are present in approximately 52% of cases 3
• Caution is advised to avoid injecting directly into the tendon substance, which can weaken the tendon and predispose to rupture 2, 1

Physical Modalities

• Therapeutic ultrasound and low-level laser therapy have shown effectiveness for De Quervain's tenosynovitis 4
• These modalities may decrease pain and increase the rate of collagen synthesis, though evidence for consistent benefit is limited 2

Third-Line Management

Surgical Intervention

• Surgery should be reserved for patients who have failed 3-6 months of conservative therapy 1
• Surgical release of the first dorsal compartment can provide high success rates, with most patients returning to normal activities pain-free 1, 5
• Preoperative ultrasound to identify anatomical variations, such as a septum within the compartment, may improve surgical outcomes 1

Treatment Outcomes and Considerations

Expected Outcomes

• Approximately 80% of patients will fully recover within 3-6 months with appropriate conservative management 1
• However, about 14% of patients may experience recurrence of symptoms, particularly those with anatomical subcompartments 3

Common Pitfalls to Avoid

• Misdiagnosis as osteoarthritis of the first carpometacarpal joint or intersection syndrome 1
• Overreliance on corticosteroid injections without addressing contributing mechanical factors 1
• Premature return to aggravating activities before adequate healing 1
• Delayed referral for surgical consultation when conservative measures have failed after 3-6 months 1
• Failure to identify anatomical variations such as multiple subcompartments, which may affect treatment response 3

Emerging Treatments

• Neural therapy has shown promise in reducing pain and improving hand function in recent studies 6
• Ultrasound-guided percutaneous needle tenotomy with platelet-rich plasma injection has been reported as a successful treatment in case reports 7