Steroid Injections for De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is a painful inflammation of the tendons on the side of your wrist and thumb called the abductor pollicis longus (APL) and extensor pollicis brevis (EBP). These tendons are the ones that lift the thumb away from the hand. Tendons may become thickened from acute or repetitive trauma, which causes the tendons to rub against the sheath they glide through.
Symptoms of De Quervain’s tenosynovitis
- Pain, tenderness and swelling on the side of the wrist toward the thumb.
- Pain is usually worse with any movement of the thumb and gripping.
- Painful when lifting something with arms in front and thumbs pointed towards the ceiling (e.g. lifting a child).
Causes of De Quervain’s
Pain can start suddenly from a direct blow or gradually from overuse.
- De Quervain’s is the second most common hand and wrist problem during pregnancy and the postpartum period. Fluid retention during the third trimester of pregnancy and repetitive picking up of the baby can predispose mothers to bilateral symptoms (Afshar et al, 2021).
- De Quervain’s may also occur after doing a lot of lifting or repetitive hand movements, such as gardening or painting.
- De Quervain’s is also considered a work-related musculoskeletal disorder of the upper limb, particularly after excessive typing (Sluiter et al, 2001).
The APL and EPB are two of the main tendons which assist the thumb with moving away from the index finger and straightening the joints of the thumb. The tendons arise from muscles in the forearm and then run together within a sheath which reduces friction and protects the tendon. The sheath also keeps the tendons close to the bone as they cross over from the thumb side of the wrist to the hand. This allows the tendons to stay in place and move freely when using the thumb. If the two tendons become thickened, this causes them to rub against the sheath.
How to diagnose
At your consultation, one of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis. The assessment will include checking your thumb and wrist range of movement, strength and flexibility of the surrounding musculature and special tests to diagnose your pain. An ultrasound scan may be performed to assess tendon damage and visualise any local inflammation at the tendons.
Generally, mild-moderate De Quervain’s syndrome will settle with conservative treatment including physiotherapy.
Physiotherapy may include the following to help settle your symptoms:
- Independent exercise program to stretch and strengthen the wrist, thumb and forearm.
- Provision of a thumb spica to be used for 4-6 weeks to rest the tendons and protect from tasks that increase pain, such as lifting.
- Advice on over the counter anti-inflammatories such as ibuprofen, unless contraindicated.
- Advice on avoiding aggravating activities. Otherwise, education on modifying trigger activities, such as lifting infants in a different way to prevent flare ups.
- Ergonomic advice and work station assessment.
De Quervains Tenosynovitis Injection Therapy
If symptoms have not improved with physiotherapy after 2-6 weeks, or if the pain is affecting your sleep, stopping you from performing everyday activities such as getting dressed or is limiting you from performing your physiotherapy exercises you may want to consider an ultrasound guided steroid injection. A cortisone injection is useful to reduce tendon sheath inflammation.
Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance. Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).
Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications
Sluiter, J.K, Rest, K.M and Frings-Dresen, M.H. (2001). Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scandinavian Journal of Work, Environment and Health. 27(1). pp.1-102.