Treatment

If De Quervain's disease is diagnosed early in its course then conservative therapy with avoidance and modification of exacerbating movements plus thumb splints may be all that is required.

• management: (1)
  • involves avoidance and modification of exacerbating thumb and wrist movements
    • thumb splints (spicas) can provide immediate relief
      • essential when prescribing a splint to make sure it is a specific thumb splint rather than a wrist splint that does not immobilise the thumb
      • to avoid confusion it is best to prescribe a 'thumb spica' rather than a splint.
      • these should be used for 4-6 weeks along with a course of NSAIDs
    • in resistant cases a corticosteroid injection into the tendon sheath is often very effective. (2) Resistant cases can be referred for ultrasound-guided injections or surgical decompression which may be done endoscopically (3)
      • if the condition is chronic then an operation may be required which involves slitting the thickened lateral wall of the tendon sheath (3)

References:

1. Arthritis Research UK (April 2013). The upper limb in primary care. Part 2: Wrist, hand. Hands On 2(7).
2. Cavaleri R, Schabrun SM, Te M, et al. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: a systematic review and meta-analysis. J Hand Ther. 2016;29:3-11.
3. Kang HJ, Koh IH, Jang JW, et al. Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial. Bone Joint J. 2013;95-B:947-951.