From the Research
De Quervain's tenosynovitis should be treated with corticosteroid injections (CSI) alone, as this approach has been shown to be highly effective with success rates of 60-90% and does not require immobilization, which can increase costs and hinder activities of daily living 1, 2.
Treatment Overview
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. The mainstay of treatment is corticosteroid injection (CSI), which can provide optimal symptomatic relief 3.
Conservative Management
Treatment typically begins with conservative measures including rest, ice, and anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
- A thumb spica splint is not necessary as immobilization does not contribute to improved patient outcomes 1.
- Corticosteroid injections into the tendon sheath are highly effective for persistent symptoms.
Surgical Intervention
For severe cases unresponsive to conservative treatment for 4-6 months, surgical release of the first dorsal compartment may be necessary 3, 4.
- Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy.
- Endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury.
Special Considerations
Pregnant women and new mothers are particularly susceptible due to hormonal changes and childcare activities, but corticosteroid injections are not contraindicated in these patients 3.
- Modifying activities that aggravate symptoms is essential for recovery and preventing recurrence.
Evidence-Based Recommendation
The most recent and highest quality study 2 supports the use of CSI alone as the first-line treatment for patients with De Quervain's tenosynovitis, as it is associated with statistically significant short- and mid-term benefits.