From the Guidelines
Radial styloid tenosynovitis, commonly known as de Quervain's tenosynovitis, is a painful condition affecting the tendons on the thumb side of the wrist. It 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. This inflammation causes the tendon sheath to swell, making thumb and wrist movements painful. The condition typically results from repetitive hand or wrist movements, such as gripping, grasping, or pinching, and is common among new parents who frequently lift their babies, as well as people who perform repetitive hand activities like gardening, knitting, or certain sports. Some key points to consider in the diagnosis and treatment of radial styloid tenosynovitis include:
- The use of MRI or US as alternative initial examinations to diagnose infectious and noninfectious tenosynovitis in both the flexor and extensor wrist compartments, as recommended by the American College of Radiology 1.
- Treatment usually begins with conservative measures including rest, ice application, and anti-inflammatory medications.
- A thumb spica splint worn for 2-3 weeks can immobilize the affected area and promote healing.
- If these approaches don't provide relief, a corticosteroid injection into the tendon sheath often helps reduce inflammation.
- Physical therapy exercises to strengthen the wrist and improve range of motion may be recommended during recovery.
- In persistent cases that don't respond to conservative treatment, surgery might be necessary to release the tight compartment around the tendons, as supported by studies such as the one published in the American Family Physician in 2005 1.
From the Research
Definition and Symptoms
- Radial styloid tenosynovitis, also known as de Quervain's disease, is a disorder characterized by pain on the radial (thumb) side of the wrist and functional disability of the hand 2, 3, 4, 5.
- The condition is often accompanied by limitation of abduction of the thumb and can lead to joint pain that worsens with activity 2, 3.
- The diagnosis of de Quervain's disease can be easily missed unless the examining physician constantly keeps it in mind 2.
Treatment Options
- Therapeutic methods for radial styloid tenosynovitis can be divided into conservative treatment and surgical treatment 3.
- Conservative treatment, such as rest, massage, cold and heat packs, wrist splints, braces, physical therapy, thumb spica casts, and local steroid injections, has been used with mixed results to treat de Quervain's tenosynovitis 4, 5.
- Surgical treatment, like releasing the first dorsal wrist compartment, is the last resort for resistant cases of de Quervain's tenosynovitis, exhibiting an efficacy of 91% 5.
- Arthroscopic treatment has also been shown to be effective in treating stenosing tenosynovitis of the radial styloid process, with less operation trauma and complications compared to traditional operation and local blocking therapy 6.
Efficacy of Treatment
- Corticosteroid injections have been found to be superior to thumb spica splinting in providing pain relief for de Quervain's tenosynovitis, with a number needed to treat to benefit (NNTB) of 1 4.
- Local intralesional steroid injections have been shown to be effective in providing pain relief for de Quervain's tenosynovitis, with an efficacy rate of 86.81% in a Pakistani cohort 5.
- The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in only a few trials, and more research is needed to fully understand its effects 4.