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Ultrasound Guided De Quervains Tenosynovitis Steroid Injection
What is De Quervain's Tenosynovitis?
De Quervain's Tenosynovitis refers to inflammation of the tendons responsible for thumb movements. It can result in extreme wrist pain and tenderness at the outer aspect of the wrist, next to the thumb base. De Quervain's Tenosynovitis is more common in manual workers and new parents (particularly mums) but can develop without an obvious reason. Ultrasound is excellent in diagnosing the condition and ruling out other causes of pain at the base of the thumb. Treatment usually starts with conservative management, including anti-inflammatory tablets, wrist/thumb support, activity modification and physiotherapy. An ultrasound-guided steroid injection can be considered in resistant cases to reduce inflammation and provide quick pain relief.
Relevant anatomy
De Quervain's Tenosynovitis refers to the inflammation of two tendons that run close to the thumb base: The abductor pollicis longus (APL) and extensor pollicis brevis (EBP). These are located on the outside of the wrist and can be easily seen when you lift your thumb. The tendons are surrounded by a thin layer (called tendon sheath) containing a small volume of special fluid to ensure smooth gliding of the tendons when moving your thumb. The tendons are held in position next to the bone by a special structure (called the extensor retinaculum) that runs on top of the tendons.
What are the causes of De Quervain's Tenosynovitis?
De Quervain Tenosynovitis can occur from overusing the thumb. It results from irritation of the APL and EPB tendons, which can be caused by frequent and repetitive thumb movements. This condition can be seen in manual workers who engage in forceful gripping movements and new parents, especially mothers, who care for their new-borns and have increased thumb activity. However, in some cases, the cause is unknown.
What are the symptoms of DeQuervain's Tenosynovitis?
DeQuervain's Tenosynovitis Symptoms include:
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Swelling and pain in the wrist, at the thumb side.
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Painful thumb movements
What conditions can be mistaken for De Quervain's Tenosynovitis?
Other conditions that can be confused with DeQuervain's Tenosynovitis include:
De Quervain Tenosynovitis vs thumb arthritis
The two conditions can be very similar, presenting with pain and swelling. De Quervain's Tenosynovitis tends to affect the side of the wrist (the radius), while thumb arthritis is located at the base of the thumb. De Quervain Tenosynovitis is more common in younger people, while thumb arthritis is common in people over 50.
De Quervain's Tenosynovitis vs Carpal Tunnel Syndrome
Both conditions may lead to pain in your thumb. Carpal tunnel syndrome also affects the index and middle fingers, causing pins and needles and numbness, worsening symptoms at night. Thumb arthritis pain, on the other hand, is typically felt in the early morning or after periods of inactivity.
How to diagnose De Quervain's Tenosynovitis?
If you are suspected of having De Quervain's Tenosynovitis, you will be assessed clinically and referred for musculoskeletal ultrasound. The ultrasound examination accurately detects inflammation of the tendons and tendon sheath and rules out other possible causes of wrist pain, such as tendon tears, wrist or thumb arthritis, and carpal tunnel syndrome. Ultrasound assessment will establish the diagnosis and assess the severity of the condition.
How to treat DeQuervain's Tenosynovitis?
The treatment starts by using over-the-counter anti-inflammatory tablets like ibuprofen. A special splint (thumb spica splint) can rest and support the tendons. This is particularly useful at night to keep the thumb in a safe position and is usually trialled for approx. 6 weeks. Also, treatment involves thumb and wrist strengthening, stretching exercises, and avoiding activities that can stress the thumb tendons more.
Can a steroid injection help with De Quervain's Tenosynovitis?
If the previously mentioned solutions are ineffective, an alternative option is an ultrasound-guided steroid injection. Cortisone injections are commonly used to treat inflammatory conditions like tendonitis. This method has been proven to deliver positive results and provide quick pain relief for patients suffering from De Quervain's Tenosynovitis. Using ultrasound guidance ensures accuracy.
What is a cortisone injection?
Corticosteroid (cortisone) is a strong anti-inflammatory medicine routinely used to manage inflammatory conditions (like bursitis, arthritis, and tendinosis). A cortisone injection will directly reduce the inflammation and pain in the injected area. To find out more, please see our FAQs.
Should hand & wrist injections be done under ultrasound guidance?
Yes. This is our routine practice, as plenty of evidence supports ultrasound guidance when performing joint injections. Doing hand and thumb injections under ultrasound/imaging guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation (like a bursa, an arthritic joint, or an inflamed tendon sheath). Ultrasound guidance results in more accurate, less painful, and faster procedures, with better outcomes than these injections without guidance. Ultrasound guidance avoids sensitive structures (like nerves and vessels) during the procedure.
Are wrist tendon cortisone injections safe?
These injections are generally very safe and routinely done in our practice. There is a very small risk of infection (about 1:10.000). There is a very small risk of focal skin colour changes at the injection site. The procedure will be explained in detail during your appointment, and all your questions will be addressed. To find out more about cortisone injections in general, please see our FAQs.
What are the commonly used steroid medicines in wrist injections?
Triamcinolone (Kenalog) and methylprednisolone (Depo-medrone) are commonly used steroid injections for musculoskeletal conditions. These preparations are long-acting steroid injections that normally take a few days to start working.
How long will the effect of a De Quervain's Tenosynovitis injection last?
Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer. Pain relief duration depends on the condition's diagnosis and severity. The steroid injection will provide a window of opportunity to undergo effective rehabilitation and attempt to address the underlying cause to enhance the pain relief achieved from the injection.
How soon will a steroid injection start to work?
A steroid injection usually takes a few days (1-3) before you notice the effect, although sometimes the pain relief can start on the same day. The injected area will often feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection.
Do steroid injections just hide/mask the pain?
Steroid injections do not just mask or hide the pain, but they act by reducing the inflammation in the targeted area, thus providing a strong and local anti-inflammatory effect to help control the symptoms and allow the patient to manage the condition, usually by undergoing effective rehabilitation.
Are De Quervain's Tenosynovitis injections painful?
Pain is very subjective, and people have different pain thresholds. Most patients experience discomfort during the injection, but the corticosteroid is usually mixed with a local anaesthetic (numbing medicine) to relieve pain. This will provide immediate pain relief that usually lasts for a few hours. We use ultrasound guidance to ensure the procedure is quick and efficient. Ultrasound ensures needle visualisation to choose the safest path for the injection and avoid any important or sensitive structures.
How long should I rest after a De Quervain's Tenosynovitis injection?
Usually, we advise patients to rest the wrist for 48-72 hours after injection.
What is the alternative if a steroid injection does not help?
If injection therapy is not helping with De Quervain's tenosynovitis, surgical treatment to release the tendons can be considered. This is best discussed with a specialist wrist and hand surgeon.
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What is De Quervain's Tenosynovitis?
What are the causes of De Quervain's Tenosynovitis?
What are the symptoms of DeQuervain's?
Mimics of De Quervain's Tenosynovitis
De Quervain Tenosynovitis vs thumb arthritis
How to diagnose De Quervain's Tenosynovitis?
How to treat DeQuervain's Tenosynovitis?
Steroid injections and De Quervain's Tenosynovitis?
FAQs about cortisone injections in De Quervain's
Hand & Wrist conditions and treatments
Specialist Consultant Musculoskeletal Radiologist Doctor with extensive experience in image-guided intervention
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Call us on 020 8050 9885 or Book online
The Musculoskeletal Ultrasound & Injections clinic
Brentford, TW8 9DR
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