De Quervain’s tenosynovitis is a painful condition affecting the tendons of the thumb and wrist. So, it is unsurprising that patients ask about a De Quervain’s tenosynovitis injection. But should you have a steroid injection for DeQuervain’s tenosynovitis? 

What is De Quervain’s tenosynovitis? 

picture of wrist with inflamed de quervains tenosynovitis

De Quervain’s tenosynovitis is a painful inflammation of the tendons on the side of your wrist and thumb. When the tendons rub against the sheath, it causes pain and swelling at the base of the thumb and forearm. Pain can start suddenly from a direct blow or gradually from overuse. Generally, pain is usually worse with any thumb movement, particularly when grabbing objects. 

Often, there is pain and swelling on the side of the wrist toward the thumb. A particular test called Finkelstein’s test is usually positive. The thumb is bent toward the palm, and the fingers are wrapped around the thumb. This movement stretches the tendon, causing pain.

De Quervain’s tenosynovitis ultrasound 

Generally, the clinical diagnosis is evident based on the history and clinical examination. However, if your doctor can do a diagnostic ultrasound, the diagnosis can be confirmed at the first consultation.

Ultrasound shows typical findings of thickening and swelling of the tendons at the base of the thumb. In addition, we often see swelling in the sheath of the tendons, consistent with inflammation.

De Quervain’s tenosynovitis vs. Carpal tunnel syndrome: How do you tell the difference? 

Both conditions can cause pain in the thumb. Generally, carpal tunnel syndrome also causes pain in the palm, index, and middle finger. Also, people with carpal tunnel syndrome describe numbness and pins and needles in the thumb. Usually, the pain worsens at night and settles by shaking the wrists.

de Quervain's tenosynovitis

Who typically suffers from De Quervain’s tenosynovitis? 

This condition usually occurs in those who perform repetitive thumb and wrist movements, such as tradespeople, chefs, and gardeners. Also, women are more likely to suffer from this condition than men. Moreover, new mums are at risk from the repeated carrying of the newborn and hormonal changes.

What treatments are available? 

Generally, treatment aims to reduce inflammation in the tendons so you can move your thumb without pain.

Usually, you’ll start with over-the-counter anti-inflammatories such as ibuprofen or naproxen. Next, a Thumb spica splint for 4-6 weeks can be helpful to rest the tendons. Finally, a referral to a hand therapist for stretching and strengthening exercises from your thumb, wrist, and forearm will help.

What about a De Quervain’s tenosynovitis injection?

A cortisone injection helps reduce tendon sheath inflammation in cases that fail simple treatment. Ultrasound is used to confirm the site of specific inflammation. A scan will also help direct the needle into the small tendon sheath containing the inflamed De Quervain tendons. Sometimes, the needle must be directed to more than one area in the tendon sheath. In addition, a local anaesthetic can reduce pain and make a De Quervain’s tenosynovitis cortisone injection more comfortable. Also, ultrasound reduces side effects like skin thinning, depigmentation, infection, and tendon damage.

Generally, most patients experience pain relief after a few days. Hand therapy is also crucial after De Quervain’s injections to regain function.

You can repeat De Quervain’s tenosynovitis cortisone injection, but we recommend only three injections for the same wrist.

Ultrasound-guided injections require years of training and expertise. If you’re considering getting a De Quervain’s tenosynovitis injection, you should do your homework first. These are four questions you should ask before having an ultrasound-guided injection.

Are there other options besides a De Quervain’s tenosynovitis injection?

Yes. Surgery to release the tendons is recommended in cases that fail simple treatment and one to two De Quervain’s injections.

Recently, some doctors have been performing a hybrid release using a special needle with a small blade. This needle releases the tendon using ultrasound. This needle release does not involve sutures and has less downtime than open surgery.

Other frequently asked questions about De Quervain’s tenosynovitis injection.

De Quervain’s tenosynovitis vs carpal tunnel syndrome: how can you tell? 

Usually, De Quervain’s tenosynovitis causes pain and swelling at the base of the thumb. Usually, pain occurs while using the thumb. Also, it is uncommon to experience numbness and pins and needles, unlike carpal tunnel syndrome. 

De Quervain’s tenosynovitis injection technique: should you use ultrasound?

Yes. Using ultrasound improves the accuracy and effectiveness of a De Quervain’s tenosynovitis injection. It also reduces side effects by ensuring cortisone is directed into the tendon sheath, not the soft tissue. You should see a doctor experienced in performing ultrasound-guided injections. If you’re considering an ultrasound-guided injection, ensure you see a doctor and not another practitioner (such as a physiotherapist, podiatrist or beauty therapist). 

Final word from Sportdoctorlondon about steroid injection for De Quervain’s tenosynovitis 

Overall, De Quervain’s tenosynovitis is a painful condition. It would be best to try simple treatments, such as a thumb spica splint, anti-inflammatory tablets, and creams like ibuprofen. In severe cases, we recommend a steroid injection for De Quervain’s tenosynovitis to reduce inflammation and pain, followed by hand therapy. Surgery should only be used as a last resort. 

Other elbow and hand conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.