Management of de Quervain Tenosynovitis

Larsen, Christopher G.; Fitzgerald, Michael J.; Nellans, Kate W.

doi:10.2106/jbjs.rvw.21.00069

Cited by 11 publications

(11 citation statements)

References 79 publications

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“…Corticosteroid injection is a commonly implemented intervention. While previous studies suggest that corticosteroid injection may be effective in reducing de Quervain’s syndrome symptoms, 61 recurrence rates as high as 48% have been reported. 62 The literature, supported by the findings in this study, suggests that a proportion of people with de Quervain’s syndrome elect to trial conservative interventions before progressing to more invasive interventions of injection or surgery.…”

Section: Discussionmentioning

confidence: 91%

Isometric thumb extension exercise as part of a multimodal intervention for de Quervain’s syndrome: A randomised feasibility trial

et al. 2023

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Introduction de Quervain’s syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain’s syndrome and to explore differences between high-load and low-load isometric exercise. Methods This parallel-group randomised clinical feasibility trial included individuals with de Quervain’s syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Results Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time ( p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusions Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain’s syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.

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Section: Discussionmentioning

confidence: 91%

Isometric thumb extension exercise as part of a multimodal intervention for de Quervain’s syndrome: A randomised feasibility trial

et al. 2023

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“…Nonoperative first-line treatment for de Quervain tenosynovitis consists of nonsteroidal anti-inflammatory drugs, thumb spica immobilization (splint immobilizing the wrist and thumb), or corticosteroid injection. Other nonoperative therapies include laser therapy, acupuncture, and placebo injection . A 2015 meta-analysis of 5 RCTs including 185 patients concluded that corticosteroids were associated with superior resolution of symptoms (84% vs 31%; RR, 2.59; 95% CI, 1.25 to 5.37; P = .05), pain relief (visual analog scale mean difference, −2.51; 95% CI, −3.11 to −1.9; P < .001), and functional improvement compared with that of control groups (splinting, placebo injection, and acupuncture) .…”

Section: Methodsmentioning

confidence: 99%

“…When nonoperative treatment fails, operative treatment consists of releasing the first dorsal extensor compartment through open, endoscopic, or percutaneous approaches. Efficacy of open release is largely based on retrospective case series, with success rates of approximately 91% based on symptom relief in a case series of 43 patients . In an RCT of 52 patients with de Quervain tenosynovitis, compared with open release, endoscopic release of the first dorsal compartment reduced transient injuries to the radial sensory nerve (11% vs 36%; P = .03) and attained earlier symptom relief (mean visual analog scale pain score at 12 weeks [range of no pain, 0 to severe pain, 10], 2.7 vs 3.8; P = .01) and greater satisfaction with the surgical scar (mean visual analog scale score [range of not satisfied, 0 to fully satisfied, 10], 8.0 vs 6.1; P < .001) than did open release …”

Section: Methodsmentioning

confidence: 99%

“…Other nonoperative therapies include laser therapy, acupuncture, and placebo injection. 58,59 A 2015 metaanalysis of 5 RCTs including 185 patients concluded that corticosteroids were associated with superior resolution of symptoms (84% vs 31%; RR, 2.59; 95% CI, 1.25 to 5.37; P = .05), pain relief (visual analog scale mean difference, −2.51; 95% CI, −3.11 to −1.9; P < .001), and functional improvement compared with that of control groups (splinting, placebo injection, and acupuncture). 60 A 2016 meta-analysis of 6 RCTs (334 patients) reported that combined treatment with injection and immobilization was associated with a better outcome, defined by a negative Finkelstein test result and significant reduction in pain compared with baseline, than injection alone (90% vs 66%; RR, 0.76; 95% CI, 0.64-0.89) or than immobilization alone (86% vs 47%; RR, 0.53; 95% CI, 0.35-0.80).…”

Section: Referral Treatment and Outcomesmentioning

confidence: 99%

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Common Hand Conditions

Currie

Tadisina

Mackinnon

2022

JAMA

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ImportanceCarpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability.ObservationsCarpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension (“triggering”) of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments.Conclusions and RelevanceCarpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.

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“…De Quervain's disease is a common stenosing tenosynovitis that affects tendons in the first extensor compartment as a degenerative condition. 1 Severe pain and limitation of motion around the radial sides of the wrist and thumb restricts daily life activities, and the symptoms can sometimes persist for quite a long time. First-line conservative treatment consists of rest, activity modification, and oral analgesic or nonsteroidal anti-inflammatory agent administration.…”

Section: Introductionmentioning

confidence: 99%