Clinical Implications and Treatment Algorithm for Patients with de Quervain’s Tenosynovitis

Purpose: De Quervain’s tenosynovitis can be a debilitating condition affecting the first dorsal compartment of the wrist. Depending on the severity, patients experiencing this pathology often lose significant functionality in the affected wrist. Upon diagnosis, non-surgical treatment is the standard of care, but failure of conservative treatments can lead to the need for surgical intervention. The main purpose of this study was to report the clinical implications and treatment algorithm for patients presenting with de Quervain’s tenosynovitis. The secondary purpose was to report clinical differences in patients that chose surgical intervention following conservative management for de Quervain’s tenosynovitis.
Methods: Following initial consultation with the treating orthopedic surgeon and throughout the conservative management time frame, 240 injuries (93%) were splinted, 230 (89%) patients were given an oral NSAID, and patients spent an average of 12 ± 6.9 weeks in occupational therapy for treatment of their injuries. In addition, 165 (64%) received an initial cortisone injection into the first dorsal extensor tendon compartment of the wrist. 44-Forty-four (17%) of these patients received a second cortisone injection, and 6 (2%) received a third cortisone injection with at least 2 to 3 months between each injection.
Result: Our study found that following conservative management there was significant improvement in the severity of symptoms, which was recorded using visual analog scale (VAS) scores. However, 58 (22%) patients converted to surgical release for de Quervain’s tenosynovitis, reported a higher post-management severity of symptoms (p<.001) than the patients who were solely treated conservatively.
Conclusions: Patients showed significant improvement following conservative treatment, such as splinting, NSAIDs, occupational therapy and corticosteroid injections. This study also confirms that patients who are surgically treated are associated with higher pain levels post-conservative treatment and post-management than those solely treated conservatively. Finally, this data suggests that those patients in this patient population who experience de Quervain’s tenosynovitis through traumatic onset are more likely to require surgical intervention.

Keywords: De Quervain’s Tenosynovitis; Conservative Treatment; Treatment Algorithm; Clinical; Hand and Wrist

Abbreviations: Splinting: thumb spica splinting; NSAIDs: Nonsteroidal Anti-inflammatory Drugs; OT: Occupational Therapy