Management Strategies for De Quervain's Tenosynovitis

De Quervain's tenosynovitis is a stenosing inflammation of the first dorsal wrist compartment, characterised by pain and functional limitation of thumb motion. Initial management revolves around conservative measures: activity modification to reduce repetitive radial deviation, non‐steroidal anti-inflammatory drugs for symptom relief and immobilisation of the thumb and wrist via splinting. Physical therapy, including manual techniques and progressive loading exercises, aims to restore tendon gliding and strength. When conservative measures fail, local corticosteroid injection into the tendon sheath offers targeted anti-inflammatory action and can achieve significant short-term and long-term symptom relief. For refractory or recurrent cases, surgical decompression of the first dorsal compartment may be indicated. Both open and minimally invasive tendoscopic techniques seek to release the constricted retinacular sheath, with emerging evidence favouring endoscopic approaches for faster recovery and improved cosmetic outcome. Choice of management should be guided by severity, patient preference and occupational or recreational demands, with an emphasis on early diagnosis and a stepped care pathway to optimise functional restoration and minimise time away from work.

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Management Strategies for De Quervain's Tenosynovitis publication trend

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Technical terms

Tenosynovitis: Inflammation of the lining (synovium) surrounding a tendon, leading to pain and restricted movement.

Finkelstein’s test: A clinical manoeuvre in which the thumb is flexed into the palm and the wrist ulnarly deviated, eliciting pain over the radial styloid in positive cases.

Corticosteroid injection: Administration of a steroid preparation into the tendon sheath to reduce inflammation and alleviate pain.

Splinting: Immobilisation of the thumb and wrist, often using a thumb spica cast or brace, to limit tendon movement and allow healing.

Tendoscopic release: A minimally invasive surgical technique using an endoscope to visualise and release the constricted retinaculum over the first dorsal compartment.

References

1. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders (2009).
2. Methylprednisolone acetate injection with casting versus casting alone for the treatment of De-Quervain's Tenosynovitis: a randomized controlled trial.. Journal of the Pakistan Medical Association (2020).
3. Tendoscopic versus open release for de Quervain’s disease: earlier recovery with 7.21 year follow-up. Journal of Orthopaedic Surgery and Research (2019).