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 cortisone injection for De Quervain’s tenosynovitis. But should you have a steroid injection for De Quervain’s tenosynovitis?
What is De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is a painful inflammation of the tendons on the thumb side of your wrist. When the tendons rub against the sheath, they cause 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 worse with any thumb movement, particularly when grabbing objects.
Often, there is pain and swelling on the thumb side of the wrist. A specific test, 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. Using a computer mouse may produce more thumb pain.
Sometimes, this condition can presents as a lump on the side of the wrist, although you need to consider other causes of a lump.
De Quervain’s tenosynovitis ultrasound
Generally, we make a diagnosis based on the history and examination. However, if your doctor can do a diagnostic ultrasound, the diagnosis can be confirmed at the consultation.
Ultrasound shows typical findings of tendon thickening and swelling. In addition, we often see swelling in the tendon sheath.
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 wrist and fingers. People with carpal tunnel syndrome report numbness and pins and needles in the thumb. Usually, the pain worsens at night and is relieved by shaking the wrists.
Who typically suffers from De Quervain’s tenosynovitis?
This condition usually occurs in those who perform repetitive movements, such as tradespeople, chefs, and gardeners. Women are more likely to suffer from this condition. Moreover, new mothers are at risk from 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, we start with simple anti-inflammatories such as ibuprofen or naproxen. Next, a Thumb spica splint for 4-6 weeks can help rest the tendons. Finally, a referral to a hand therapist for exercises for your thumb, wrist, and forearm will help.
What about a De Quervain’s tenosynovitis injection?
A cortisone injection helps reduce tendon sheath inflammation for cases that fail simple treatments.
Generally, we recommend ultrasound-guided injections. There are many advantages to using ultrasound. First, an ultrasound can confirm the diagnosis and exclude other causes of wrist pain. Second, doctors can direct the needle into the correct spot, making the injeciton more accurate and effective. Finally, because ultrasound is more precise, it can help ensure that cortisone does not leak into the soft tissue, reducing side effects such as skin thinning, depigmentation, infection, and tendon damage.
Most patients experience pain relief after a few days. Hand therapy is also crucial after De Quervain’s injections to regain function. A recent study found that 93% of patients with De Quervain’s tenosynovitis achieved complete pain relief with 1 or 2 ultrasound-guided cortisone injections.
You can repeat the cortisone injection for De Quervain’s tenosynovitis, but we recommend no more than three injections in 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.
Some doctors perform a release using a special needle with a small blade. This needle releases the tendons using ultrasound. This needle release does not require sutures and allows faster recovery 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?
De Quervain’s tenosynovitis usually causes pain and swelling at the base of the thumb. The pain usually occurs while using the thumb. Also, unlike carpal tunnel syndrome, numbness and pins-and-needles sensations are uncommon.
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 that cortisone is delivered to the tendon sheath rather than the surrounding soft tissue.
A recent study found that ultrasound-guided De Quervain’s injections cured 93% of patients, compared with 78% with a blind injection. About 29% of patients get a recurrence of pain after a cortisone injeciton and need another.
You should see a doctor who is experienced in performing ultrasound-guided injections. If you’re considering an ultrasound-guided injection, ensure you see a doctor and not another practitioner.
How does an ultrasound-guided cortisone injection compare to surgery for De Quervain’s tenosynovitis?
Both seem successful. A recent study found that effectiveness rates were the same in both groups. So, we recommend you try an ultrasound-guided injection at least once before considering release.
Final word from Sportdoctorlondon about steroid injection for De Quervain’s tenosynovitis
Overall, De Quervain’s tenosynovitis is a painful condition. Simple treatments, such as a thumb spica splint, anti-inflammatory tablets, and ibuprofen cream, would be best. In severe cases, we recommend a steroid injection to reduce inflammation and pain, followed by hand therapy. Surgery should only be used as a last resort.
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