From the FDA Drug Label
The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon For ganglia of the tendon sheaths, the suspension is injected directly into the cyst A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated.
The recommended dose for Medrol (methylprednisolone) for DeQuervain injection is 4 to 30 mg. The recommended needle size is 20 to 24 gauge 1.
From the Research
For a De Quervain's tenosynovitis injection, the recommended dose is typically 40 mg of methylprednisolone acetate (Medrol) mixed with 1 ml of 2% lignocaine hydrochloride, as this combination has been shown to provide significant improvement in patients with de Quervain's tenosynovitis 2. The recommended needle size is a 25-gauge, 1-inch needle, which provides adequate length to reach the first dorsal compartment while minimizing patient discomfort. When performing the injection, the patient's wrist should be slightly ulnar deviated to better expose the first dorsal compartment. The injection site should be at the point of maximum tenderness over the radial styloid process, and the needle should be directed along the course of the abductor pollicis longus and extensor pollicis brevis tendons. Proper technique involves inserting the needle at a shallow angle until resistance is felt, then injecting the solution slowly. Patients should be advised to rest the wrist for 24-48 hours after the injection and may experience temporary pain at the injection site. This treatment works by reducing inflammation in the tendon sheath, which helps decrease pain and improve function. If symptoms persist after 2-3 weeks, a second injection may be considered, but typically no more than three injections should be administered within a six-month period. It is also worth noting that the addition of hyaluronic acid to ultrasound-guided injections of steroids may improve the outcome and reduce the recurrence rate, as shown in a study published in 2015 3. However, the most recent and highest quality study available, which is from 2015, supports the use of 1 ml methylprednisolone acetate, and the study from 2014 2 provides more specific guidance on the dose and technique for the injection. Key points to consider when performing the injection include:
- Using a 25-gauge, 1-inch needle to minimize patient discomfort
- Injecting the solution slowly and at a shallow angle
- Advising patients to rest the wrist for 24-48 hours after the injection
- Considering a second injection if symptoms persist after 2-3 weeks
- Being aware of the potential benefits of adding hyaluronic acid to the injection, as shown in the 2015 study 3.