De Quervain Tenosynovitis: Treatment Options

De Quervain Tenosynovitis: Treatment Options

This video will provide an overview of treatment options for De Quervain tenosynovitis, both with and without surgery. De Quervain tenosynovitis involves 2 tendons that help the thumb extend. The protective covering or sheath of these tendons becomes inflamed and thickened, constricting their ability to glide freely in a tunnel in the wrist. Often, the first line approach to treating this condition begins with nonoperative methods that all share the goal of minimizing inflammation in the sheath. A frequent first step is temporarily using a thumb spica splint, preventing irritated tendons from moving.

Over-the-counter nonsteroidal anti-inflammatories may be recommended. Steroid or biologic injections may be offered to reduce the swelling and pain of the tendons. Specifically, steroid injections have a cure rate of 62-100%. If an injection fails to relieve symptoms, it may be due to abnormal anatomy of the tendons, which is a common finding in this condition. For optimal outcomes, this injection is usually paired with hand therapy. Activity modifications may be considered. Other options may be offered for this problem, such as therapeutic ultrasound techniques and acupuncture. However, their use remains limited as more research on their effectiveness is needed.

If symptoms fail to be relieved after a trial of nonsurgical treatments for several months, surgery may be considered for severe cases of this condition. Surgery can be done with an open approach, which means an incision will be needed at the base of the thumb. The surgery can also be done endoscopically with a small camera and even smaller incisions. In either case, the surgeon will release the sheath or protective covering of the tendon with a surgical scissor. This relieves pressure on the tendons, allowing free movement through the tunnel.

A surgical release is very successful, with 95% of patients reporting full resolution of symptoms. Following surgery, a patient may be placed in a thumb spica splint, followed by guided hand therapy to work on range of motion and strengthening. In summary, De Quervain's tenosynovitis has several nonsurgical treatment options such as injections, braces, and hand therapy. Surgery to release the tendon sheaths may be considered for cases that fail to respond to these treatments. Treatments with and without surgery have great success.