From the Guidelines
De Quervain's tenosynovitis should be diagnosed using MRI, as it is useful for diagnosing infectious and noninfectious tenosynovitis in both the flexor and extensor wrist compartments. When diagnosing De Quervain's tenosynovitis, it is essential to consider the patient's symptoms and medical history. The condition is characterized by pain and tenderness on the thumb side of the wrist, which can be exacerbated by repetitive hand or wrist movements.
Key Considerations
- De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, and treatment typically begins with conservative measures including rest, ice, and anti-inflammatory medications.
- MRI is a valuable diagnostic tool for De Quervain's tenosynovitis, as it can depict fluid-filled and synovial-lined structures, including ganglia, cysts, bursa, and tendon sheaths, and is useful for diagnosing infectious and noninfectious tenosynovitis in both the flexor and extensor wrist compartments 1.
- Occult ganglion cysts are also easily identified with MRI, but some authors recommend use of IV contrast to distinguish ganglia from synovitis 1.
Treatment Options
- Conservative measures such as wearing a thumb spica splint that immobilizes the thumb and wrist for 2-6 weeks, especially during activities that aggravate symptoms, can be highly effective.
- Corticosteroid injections into the tendon sheath provide significant relief in about 70% of cases.
- Physical therapy focusing on gentle stretching and strengthening exercises helps recovery and prevents recurrence.
- For severe or persistent cases not responding to conservative treatment after 4-6 months, surgical release of the tendon sheath may be necessary.
From the Research
Definition and Treatment of De Quervain's Tenosynovitis
- De Quervain's tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment 2.
- The mainstay of treatment is corticosteroid injection (CSI), and the use of ultrasound may improve the accuracy of injections and help to identify and localize injections to separate subcompartments 3.
Nonoperative Measures
- Most cases of de Quervain tenosynovitis can be managed with nonoperative measures, including CSI, anti-inflammatory medication, and occupational therapy 3, 2.
- A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation 4.
- Ultrasound-guided injections were shown to be more accurate and confer better outcomes 4.
Surgical Release
- When nonoperative treatment is unsuccessful, surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief 3, 2.
- 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 3.
- Endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury 3.
Special Considerations
- For patients who are in the third trimester of pregnancy or breastfeeding, there is no contraindication to CSI as studies have shown that it can provide optimal symptomatic relief to the mother without impacting the baby 3.
- The WALANT (wide-awake local anesthesia no tourniquet) technique can be used for FDC release, which has the potential for cost savings without compromising quality or patient comfort 3.