From the Guidelines
De Quervain's tenosynovitis of the right wrist/thumb is a painful condition that should be initially treated with conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, with the goal of reducing morbidity and improving quality of life. This condition occurs when the two tendons that control thumb movement become inflamed and irritated as they pass through a narrow tunnel or sheath at the wrist. The treatment approach is based on the principles outlined in the study by 1, which emphasizes the importance of conservative management for chronic wrist pain.
Causes and Risk Factors
The condition is typically caused by repetitive hand or wrist movements, such as gripping, grasping, or pinching, which can be exacerbated by activities like texting, gaming, or certain occupational tasks. Understanding the causes and risk factors is crucial for developing an effective treatment plan and preventing recurrence.
Conservative Treatment
Treatment usually begins with:
- Rest: Avoiding activities that aggravate the condition
- Ice application: For 15-20 minutes several times daily to reduce pain and inflammation
- Over-the-counter anti-inflammatory medications: Such as ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for 1-2 weeks
- A thumb spica splint: That immobilizes both the wrist and thumb, often recommended to be worn continuously for 2-6 weeks
Further Management
If these measures don't provide relief, a corticosteroid injection into the tendon sheath may be beneficial, as suggested by 1. Physical therapy focusing on gentle stretching and strengthening exercises can help recovery and prevent recurrence. In persistent cases that don't respond to conservative treatment for 4-6 months, surgical release of the tendon sheath might be necessary, as indicated by 1.
Prevention of Recurrence
To prevent recurrence, it's essential to:
- Modify activities that strain the thumb and wrist
- Take frequent breaks during repetitive tasks
- Maintain proper ergonomics when using electronic devices
By following this approach, patients with De Quervain's tenosynovitis can experience significant improvement in their symptoms and quality of life, as supported by the study 1.
From the Research
De Quervain's Tenosynovitis Overview
- De Quervain's tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment 2.
- It is characterized by radial side wrist pain, particularly during lifting activities.
Treatment Options
- Nonoperative measures are the mainstay of treatment, with corticosteroid injection (CSI) being the primary treatment option 3, 4.
- The use of ultrasound may improve the accuracy of injections and help identify and localize injections to separate subcompartments 3.
- Thumb spica immobilization for 3 to 4 weeks can be added to CSI for statistically significant functional benefits in the short-term and mid-term 4.
- Surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief when nonoperative treatment is unsuccessful 3, 2.
Surgical Techniques
- 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.
- The WALANT (wide-awake local anesthesia no tourniquet) technique can be used for FDC release, providing cost savings without compromising quality or patient comfort 3.