INJECTION THERAPY FOR DE QUERVAIN'S TENOSYNOVTIS

What is De Quervain’s Tenosynovitis?

DeQuervain’s tenosynovitis produces significant discomfort and swelling in the tendons that move the thumb at the wrist. The pain is on the radial side (thumb side) of the wrist, near the bone. It produces a great deal of soreness and suffering. DeQuervain’s tenosynovitis occurs for no apparent reason, but is common during pregnancy and the first year after childbirth, as well as in persons who do repetitive manual work or spend a lot of time on the internet. It is detected through an ultrasound scan and a clinical examination known as Finkelstein’s test.

Rest from uncomfortable movements, painkillers/anti-inflammatories, and a thumb spica are the first lines of treatment. If the injury is not too painful, physiotherapy may be beneficial. If your pain persists, we recommend getting a diagnostic ultrasound scan (you don’t require an MRI) to confirm the diagnosis and figure out why it isn’t getting better. An ultrasound guided steroid injection is a very successful treatment for DeQuervain’s tenosynovitis if other more conservative methods fail. Steroid injections under ultrasound supervision have a lot of evidence behind them and should be tried if your discomfort isn’t getting better. In most cases, they provide immediate pain relief.

What are the symptoms of De Quervain’s Symptoms?

The following are the signs and symptoms of DeQuervain’s tenosynovitis:

  • On the thumb side of the wrist, there is pain, soreness, and swelling.
  • All thumb movements cause pain.
  • On the radial side (thumb side) of the wrist, there is a point of soreness on the bone.
    If this sounds like you, keep reading…

What are some additional conditions that are similar to De Quervain’s Tenosynovitis?

  1. Osteoarthritis of the wrist
  2. Carpal tunnel syndrome
  3. Osteoarthritis of the thumb
  4. Triangular fibrocartilage complex (TFCC) tear
  5. Scapholunate ligament injury

De Quervain’s Tenosynovitis vs Osteoarthritis (OA) of the thumb:

One of the significant differences between DeQuervain’s tenosynovitis and osteoarthritis of the thumb is the site of the discomfort. DeQuervain’s tenosynovitis is a type of tenosynovitis that causes very localised discomfort and tenderness on the radial (thumb) side of the wrist, which is increased by thumb movements. OA thumb, on the other hand, causes widespread pain, stiffness, and swelling towards the base of the thumb. DeQuervain’s disease is more common in younger men and women, especially women who have just given birth, whereas thumb osteoarthritis is more common in people over 50.

Anatomy:

De Quervain’s tenosynovitis is a painful disorder that affects two thumb tendons. The extensor pollicis brevis tendon (EBP) and the abductor pollicis longus tendon are these tendons (APL). These tendons can be seen running along the outer edge of the wrist. When you stick your thumb up, they appear as powerful rope-like structures!). These tendons are protected by a sheath that reduces friction and is maintained in place by a structure known as the extensor retinaculum. When you use your thumb to perform things like use your phone or type, this system keeps the tendons in place and allows them to move freely.

How does De Quervain’s Tenosynovitis happen?

De Quervain’s tenosynovitis is a common overuse injury caused by repeated thumb movements (Carlton et al., 2002). When the EPB and APL tendons are subjected to repetitive thumb movements or after a period of increased activity, this occurs. This could occur as a result of increased typing, the commencement of a new sport that requires gripping, or the care of a newborn baby.

How do we diagnose De Quervain’s Tenosynovits?

When you come in for a consultation at Joint Injections, one of our experts will thoroughly analyse your issue before recommending the best treatment option for you. All of our specialists are extended-scope physiotherapists who are also fully qualified musculoskeletal sonographers with a lot of experience assessing and treating De Quervain’s tenosynovitis. Your evaluation will begin with a talk to determine how, why, and when your symptoms began. You will also be quizzed on your medical background. This is to rule out other medical illnesses that could be mistaken for De Quervain’s tenosynovitis, such as rheumatoid arthritis.

Following that, a number of clinical (physical) tests will be used to zero in on the structures that are causing your pain (Peters-Veluthamaningal et al., 2009). A formal diagnostic ultrasound scan will be performed once our doctor has developed a working diagnosis. This enables us to see what is causing your pain beneath the surface.

De Quervain’s tenosynovitis can be diagnosed using a diagnostic ultrasound scan that is extremely specific. Ultrasound imaging can be used to see localised local inflammation around the thumb tendons. The condition of the thumb tendons can be easily assessed for evidence of tendinopathy (tendon injury) or tear. The information gleaned from combining clinical testing and diagnostic ultrasonography results resulted in a highly accurate diagnosis and, as a result, it is possible to choose the best appropriate treatment approach.

When evaluating for De Quervain’s tenosynovitis, we make sure that any other pathologies in the wrist and hand are ruled out as possible causes of your symptoms. De Quervain’s tenosynovitis can also be caused by the following disorders in the hands and wrists:

  1. Osteoarthritis of the wrist
  2. Carpal tunnel syndrome
  3. Osteoarthritis of the thumb
  4. Scapholunate ligament injury
  5. DeQuervain’s tenosynovitis

How do we treat De Quervain’s Tenosynovits?

De Quervain’s tenosynovitis is a tough and time-consuming condition to treat. We use our hands often in our daily lives, as well as during recreational activities like as sports, computer games, and even creative pursuits such as painting. De Quervain’s tenosynovitis symptoms might last for months or even years due to our dependency on our thumbs. Many patients experience alternating periods of rest and pain flare-ups.

Before receiving an ultrasound-guided steroid injection, all patients should try conservative physiotherapy. A physiotherapist oversees the initial treatment, which may involve procedures such as;

  • Advice on how to change your activities (to help you avoid flare ups).
  • Postural correction of the upper limbs, as well as improvements to your working environment’s ergonomics.
  • Techniques for pain relief (Ice advice when suffering a pain flare).
  • The use of a brace to keep your thumb in a secure position when sleeping or performing duties that can aggravate your pain, such as lifting and moving heavy or awkward objects (see below image) (Peters-Veluthamaningal et al., 2009; Peters-Veluthamaningal et al., 2009)
  • Exercises to strengthen the thumb and forearm.
  • Stretching tips for the thumb and forearm.

What options do I have if conservative management does not work?

If PT hasn’t helped your problem, don’t despair. You still have a quick and effective solution at your disposal. For De Quervain’s tenosynovitis, steroid injections have been demonstrated to be a highly effective treatment. Your doctor will be able to inject a small dose of anti-inflammatory medication (known as a corticosteroid) and a local anaesthetic (short acting numbing agent) straight into the target area using ultrasound guidance. This is only achievable because of the technique’s excellent accuracy rates. There is no need to receive a referral or prescription from your G.P. because all of our injections are done under ultrasound guidance by a highly experienced sonographer who is fully certified to prescribe the most appropriate medication for you.

For De Quervain’s tenosynovitis, an ultrasound-guided steroid injection is usually very comfortable and well tolerated. The majority of patients will see a considerable improvement in their symptoms within a few days of receiving the injection; nonetheless, a steroid injection is not a cure-all for this ailment. It is critical to follow an injection with a period of physiotherapy rehabilitation. Rehabilitation of the wrist and hand can begin once the symptoms have subsided. Your treating doctor will be able to give you with personalised therapy recommendations.

De Quervain’s tenosynovitis is well-known for occurring during pregnancy and in mothers of small children. Please note that we do not provide injections to pregnant patients because the hazards of steroid medication transfer to the baby are unknown. We do, however, provide injections to nursing patients because the British Breastfeeding Association has proven that low-dose steroid injections do not pose a risk to the baby.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all hand and wrist disorders, including De Quervain’s tenosynovitis. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.