Quervain’s tenosynovitis is an incredibly painful condition affecting the tendons of the thumb and wrist. It is not surprising that patients ask about a De Quervain’s tenosynovitis injection. But should you have one?
What is De Quervain’s 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 that keeps the tendons close to the bone, it causes pain and swelling from the base of the thumb to the forearm. Pain can start suddenly from a direct blow or gradually from overuse. Generally, pain is usually worse with any movement of the thumb, particularly when grabbing objects.
Often, there is pain and swelling on the side of the wrist toward the thumb. A special test called Finkelstein’s test is usually positive. This is a test where the thumb is bent toward the palm and then the fingers are wrapped around the thumb. This movement stretches the tendon causing pain.
De Quervain’s tenosynovitis vs Carpal tunnel syndrome: How to tell the difference?
Both conditions can cause pain in the thumb. Generally, carpal tunnel syndrome also causes pain in the palm of the hand and the index and middle finger. Also, people with carpal tunnel syndrome describe numbness and pins and needles in the thumb. Usually, pain is worse at night and improves by shaking the wrists.
Who typically suffers from De Quervain’s tenosynovitis?
This condition usually occurs in those people who perform repetitive movements of the thumb and wrist 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 a combination of repeated carrying of the new borne and hormonal changes.
What treatments are available?
Generally, the aim of treatment is 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. A Thumb spica splint for 4-6 weeks can be useful to rest the tendons. 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?
In cases that fail simple treatment, a cortisone injection is useful to reduce tendon sheath inflammation. 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 needs to be directed to more than one area in the tendon sheath. The use of a local anesthetic can reduce pain and make the De Quervain’s injection more comfortable. Also, using ultrasound reduces side effects including skin changes such as thinning and depigmentation, infection, and tendon damage.
Generally, most patients experience pain relief after a few days. Hand therapy is also important after De Quervain’s injections to regain function.
You can have a repeat De Quervain’s injection, but we would only recommend a maximum of three injections for the same wrist.
Are there other options besides a De Quervain’s tenosynovitis injection?
Yes. In cases that fail simple treatment and one to two De Quervain’s injections, surgery to release the tendons is recommended.
Recently, some doctors are 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.
Final word from Sportdoctorlondon
Overall, De Quervain’s tenosynovitis is a painful condition. You should always try simple treatments first such as a thumb spica splint and anti-inflammatory tablets and cream such as ibuprofen. In difficult cases, we recommend an ultrasound-guided injection of cortisone to reduce inflammation and pain followed by hand therapy. Surgery should only be used as a last resort.
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