Nonsurgical Treatment for De Quervain’s Tenosynovitis

Once De Quervain’s tenosynovitis is diagnosed, nonsurgical treatments often will succeed in resolving it.

The goal of treatment for De Quervain’s tenosynovitis is to reduce the inflammation of the tendons and synovial sheaths, so that the tendons can move freely through the synovium again.

Most cases of De Quervain’s tenosynovitis can be treated without surgery. Typically, symptoms should start to improve after 4 to 6 weeks of treatment.

See Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours

Treatment Options

Nonsurgical treatment options for De Quervain’s tenosynovitis include:

• Rest. Patients should minimize wrist and thumb movement in the affected hand. This may include pinching and gripping or any repetitive hand activities. Resting the hand on a pillow or elevated surface can also help.
• Activity modification. Avoiding the activity that may have triggered the condition, such as from a sport, hobby, or employment, will give inflammation a chance to subside.
• Splint/brace. Physicians may recommend that patients wear a splint called a thumb spica splint, which immobilizes the thumb. Patients are typically instructed to wear it 24 hours a day for 4 to 6 weeks.
• Ice. Ice therapy can reduce inflammation and numb pain signals, so it’s useful for treating De Quervain’s tenosynovitis. The affected area can be iced for 10 to 15 minutes several times a day. Ice shouldn’t be applied directly to the skin, as this can cause burns.

• NSAIDs. Pain medications that also alleviate inflammation, such as ibuprofen (Advil) and naproxen (Alieve), can help ease De Quervain’s tenosynovitis symptoms. Other non-NSAID pain medications such as aspirin may also be appropriate.
• Physical therapy. A physical or occupational therapist can assist patients by teaching them exercises for the hand and thumb and ways to complete day-to-day tasks while putting minimal strain on the inflamed tendons.
• Steroid (cortisone) injections. If the above measures fail to bring relief, physicians may recommend a cortisone injection into the tendon sheath. Most patients recover from the condition after receiving injections. One study of 80 patients with De Quervain’s tenosynovitis found that 95% were symptom-free after two or three injections over the course of 6 weeks.¹Akram, M et al. Results of injection corticosteroids in treatment of De Quervain's Tenosynovitis. J Pak Med Assoc. 2014 Dec;64(12 Suppl 2):S30-3. However, these injections have a drawback in as they carry a risk of causing reactions and side effects. In the study, 25% of the patients had temporary adverse reactions to the injections, such as a cortisone flare.

See The P.R.I.C.E. Protocol Principles

If nonsurgical treatment options fail to offer relief, there is a surgical treatment option that’s simple and effective for relieving pain and resolving the condition.

See De Quervain’s Tenosynovitis Surgery