From the Guidelines
For De Quervain's tenosynovitis, typically 1-2 corticosteroid injections are recommended, as supported by the American College of Radiology's appropriateness criteria 1. When considering the treatment of De Quervain's tenosynovitis, it is essential to prioritize the number of injections to balance efficacy and potential side effects.
- The first injection usually resolves symptoms in about 50-80% of patients.
- A second injection may be offered if symptoms persist after 4-6 weeks. The injection typically consists of a mixture of a corticosteroid (such as methylprednisolone 20-40mg or triamcinolone 10-20mg) combined with a local anesthetic (like lidocaine 1%), and is injected into the first dorsal compartment of the wrist where the abductor pollicis longus and extensor pollicis brevis tendons are located, as identified by ultrasound (US) examination 1. Key considerations for the treatment include:
- Multiple injections (more than 2-3) are generally not recommended due to potential side effects including skin atrophy, depigmentation, and tendon weakening.
- If symptoms persist after two injections, surgical release of the tendon sheath may be considered. The use of US to guide therapeutic intra-articular and other soft-tissue injections, such as those for De Quervain's tenosynovitis, is a useful technique, as noted in the American College of Radiology's guidelines 1.
From the Research
De Quervain's Tenosynovitis Treatment
- De Quervain's tenosynovitis is a disorder characterized by pain on the radial side of the wrist and functional disability of the hand 2.
- The treatment options for de Quervain's tenosynovitis include corticosteroid injection, splinting, and surgery.
Corticosteroid Injection
- Corticosteroid injections are a common treatment for de Quervain's tenosynovitis, with a high success rate 3, 4, 5.
- The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in several trials, with one trial finding that 73.4% of patients experienced treatment success within 2 injections 3.
- Another study found that 82% of patients had resolved symptoms 6 weeks after a steroid injection, and over half remained symptom-free for at least 12 months 4.
- A pooled quantitative literature evaluation found an 83% cure rate with injection alone, which was higher than any other therapeutic modality 5.
Number of Injections
- The number of injections needed to treat de Quervain's tenosynovitis can vary, with some studies suggesting that one or two injections are sufficient 3, 4.
- One study found that 51.8% of patients experienced success after 1 injection, while 73.4% experienced treatment success within 2 injections 3.
- Another study found that 11 patients underwent additional intervention, including 4 repeat injections, after an initial injection 4.