From the Guidelines
De Quervain's tenosynovitis treatment should begin with conservative measures, including rest, immobilization, and anti-inflammatory medications, as these approaches have been shown to provide relief and promote healing 1.
Initial Treatment
- Rest and immobilization with a thumb spica splint worn continuously for 2-6 weeks to prevent further damage and promote healing
- Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) to reduce pain and inflammation
- Ice application for 15-20 minutes several times daily to help reduce inflammation, as cryotherapy has been found to provide acute relief of tendinopathy pain 1
Additional Measures
- Corticosteroid injections into the tendon sheath may be effective if initial measures do not provide relief, with 1-2 injections of methylprednisolone (20-40mg) or triamcinolone (10-40mg) mixed with lidocaine providing relief in up to 80% of cases
- Physical therapy focusing on gentle stretching and strengthening exercises should be initiated after acute pain subsides to promote tendon healing and prevent recurrence
- Ergonomic modifications to reduce repetitive thumb movements are essential for long-term management, as repetitive hand movements are a common cause of De Quervain's tenosynovitis
Surgical Options
- Surgery (release of the first dorsal compartment) is reserved for cases that do not respond to 4-6 months of conservative treatment, as it has been found to be an effective option in carefully selected patients who have failed conservative therapy 1
From the Research
De Quervain's Tenosynovitis Treatment Options
- Non-operative treatment:
- Operative treatment:
Effectiveness of Treatment Options
- Corticosteroid injection has been shown to be effective in resolving symptoms, providing pain relief, and improving function in patients with de Quervain's tenosynovitis 4, 5
- Adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection may provide statistically significant functional benefits in the short-term and mid-term 5
- Ultrasonography-guided corticosteroid injection ranked as the top intervention for pain in a network meta-analysis 5
Outcomes of Treatment
- A prospective study found that 62% of patients had a satisfactory outcome with injection of steroids and immobilization in a splint, while 38% had an unsatisfactory outcome and required operative release of the first dorsal compartment 6
- Operative release of the first dorsal compartment was found to be effective in 73% of patients who had previously undergone non-operative treatment 6