Treatment of De Quervain's Tenosynovitis
Corticosteroid injection into the first dorsal compartment is the most effective initial treatment for De Quervain's tenosynovitis, with an 83% cure rate, far superior to splinting alone (14%) or NSAIDs (0%). 1
First-Line Treatment: Corticosteroid Injection
- Inject a mixture of methylprednisolone (40mg) with local anesthetic into the tendon sheath of the first dorsal compartment as the preferred initial treatment 2, 3, 1
- Approximately 58-65% of patients achieve complete pain relief after a single injection within 1-2 weeks 2, 3
- An additional 33-35% of patients require a second injection 2 weeks after the first, bringing the total success rate to 90-95% by 6 weeks 2, 3
- Critical pitfall to avoid: Never inject corticosteroid into the tendon substance itself—only inject into the tendon sheath—as injection into the tendon can cause tendon weakening and predispose to rupture 4, 5, 6
Adjunctive Conservative Measures
While injection is most effective, combine with these supportive treatments:
- Thumb spica splinting to immobilize the affected tendons, but avoid complete immobilization as this leads to muscle atrophy 4, 5, 6
- NSAIDs (preferably topical to avoid GI bleeding risk) for pain relief, though they show 0% cure rate as monotherapy 4, 1
- Cryotherapy applied through a wet towel for 10-minute periods provides short-term pain relief 4, 5
- Activity modification with relative rest—avoid aggravating activities while maintaining some movement to prevent deconditioning 5, 6
When Conservative Treatment Fails
- Reserve surgery for patients who fail 3-6 months of conservative therapy including at least 2-3 corticosteroid injections 5, 6
- Surgical release of the first dorsal compartment has high success rates, with most patients returning to pain-free normal activities 6
- Consider preoperative ultrasound to identify anatomical variations such as a septum within the first compartment, which affects surgical technique 4, 6
Expected Outcomes and Follow-Up
- Approximately 80% of patients achieve full recovery within 3-6 months with appropriate treatment 6
- Recurrence occurs in some patients at a mean of 11.9 months after initial injection, but these respond well to repeat injection 3
- Only 10% of cases ultimately require surgical intervention 3
- Adverse reactions from steroid injection are self-limited and minor (occurring in 25% of patients), typically resolving within 20 weeks, with no tendon ruptures or infections reported in major studies 2, 3
Special Population Note
- In pregnant or lactating women, corticosteroid injection achieved 100% complete pain relief (9/9 patients) compared to 0% with thumb spica splinting alone (0/9 patients), with no observed side effects 7