De Quervain’s Injection

De Quervain’s Injection with steroid is used to treat the tenosynovitis of the 1st extensor compartment of the wrist.

The 1st extensor compartment of the wrist include the abductor pollicis longus and extensor pollicis brevis. De Quervain’s tenosynovitis symptoms include pain over base of thumb and styloid process of radius; occasional crepitus; painful resisted abduction, extension and passive flexion of thumb across palm with wrist in ulnar deviation (Finkelstein’s test).

Related Anatomy

The abductor pollicis longus and extensor pollicis brevis usually run together in a single sheath on the radial side of the wrist. The styloid process is always tender, so comparison should be made with the pain-free side. The two tendons can often be seen when the thumb is held in resisted extension or can be palpated at the base of the metacarpal. The aim is to slide the needle between the two tendons and deposit the solution within the sheath.

See Also: Extensor compartments of the wrist

Equipment Needed

• Syringe: 1 ml
• Needle: Orange, 25 gauge, 0.5 inch (16 mm)
• Kenalog 40: 10 mg
• Lidocaine: 0.75 ml, 2%
• Total volume: 1 ml

De Quervain’s Injection Technique

• Patient places hand vertically, with thumb held in slight flexion
• Identify gap between two tendons at base of first metacarpal
• Insert needle perpendicularly into gap, then slide proximally between tendons
• Inject solution as a bolus within tendon sheath.

The patient should rest the hand, with taping of the tendons. This is followed by avoidance or curtailment of the provoking activity and a graded muscle-strengthening regimen, if necessary.

See Also: De Quervain Tenosynovitis

Notes

Provided the wrist is not too swollen, a small sausage shaped swelling can often be seen where the solution distends the tendon sheath. This is an area where depigmentation or subcutaneous fat atrophy can occur, especially noticeable in dark skinned, thin females. Although recovery can take place, the results might be permanent. Patients should be warned of this possibility before giving their consent. The potential risk can be minimized by injecting with hydrocortisone.

A study found that De Quervain’s Injection alone is the best therapeutic approach to de Quervain’s tenosynovitis. They concluded that there was an 83% cure rate with injection alone. This rate was much higher than any other therapeutic modality (61% for injection and splint, 14% for splint alone, 0% for rest or nonsteroidal anti-inflammatory drugs).

In a double-blind randomized controlled trial to compare the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis, they found that ketorolac De Quervain’s injection resulted in inferior pain reduction, functional score and grip improvement than triamcinolone De Quervain’s injection in patients with radial styloid tenosynovitis. Future studies are required to examine the effects of ketorolac in larger group and with longer follow-up periods to further elucidate the findings of this study.

References & More

1. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/
2. Richie CA 3rd, Briner WW Jr. Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003 Mar-Apr;16(2):102-6. doi: 10.3122/jabfm.16.2.102. PMID: 12665175.
3. Suwannaphisit S, Suwanno P, Fongsri W, Chuaychoosakoon C. Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial. BMC Musculoskelet Disord. 2022 Sep 1;23(1):831. doi: 10.1186/s12891-022-05784-x. PMID: 36050704; PMCID: PMC9434938.