eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

De Quervain Tenosynovitis: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Contributor Information and Disclosures

Updated: Dec 15, 2009

Follow-up

Further Outpatient Care

  • Have the patient return for reevaluation approximately 2-4 weeks after corticosteroid injection.
  • At the time of the follow-up visit, assess for therapeutic response to the injection and evaluate for any complication or further treatment needs.
  • Instruct the patient to contact his/her physician sooner if a significant progression of symptoms is noted or if local signs of infection are present at the injection site.

Inpatient & Outpatient Medications

Deterrence

  • A patient with de Quervain's tenosynovitis may need to avoid certain repetitive activities of the wrist or thumb until adequate rehabilitation has been achieved.

Complications

  • Please see Other Treatment, which includes a discussion of potential complications of corticosteroid injections.

Prognosis

  • Most patients with de Quervain's tenosynovitis respond very well to nonsurgical treatment (eg, corticosteroid injection, splinting, physical therapy, occupational therapy).
  • For severe cases that are unresponsive to injections, refer the patient for surgical treatment to decompress the first dorsal compartment.

Patient Education

  • As with any injection, educate the patient to watch for signs or symptoms of local infection at the injection site.
  • Instruct diabetic patients that they may experience a transient increase in blood glucose levels with corticosteroid injection.
  • Educate patients that symptomatic improvement from corticosteroid injection usually is observed a few days after injection. Patients should understand that they may experience a mild, transient increase in symptoms during the period in which the local anesthetic has worn off but the steroids have not yet begun to demonstrate a noticeable therapeutic effect.
  • For excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center and Sprains and Strains - First Aid and Emergency Center. Also, see eMedicine's patient education articles Repetitive Motion Injuries and Sprains and Strains.

Miscellaneous

Medicolegal Pitfalls

  • Complications are possible with any injection. The patient needs to understand the potential risks prior to giving informed consent for injection.
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with a revision of this manuscript.

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with a revision of this manuscript.

Jason Lee, 4th year medical student, St. George's University School of Medicine, Class of 2010, assisted with the 2009 revision of this manuscript.



More on De Quervain Tenosynovitis

Overview: De Quervain Tenosynovitis
Differential Diagnoses & Workup: De Quervain Tenosynovitis
Treatment & Medication: De Quervain Tenosynovitis
Follow-up: De Quervain Tenosynovitis
Multimedia: De Quervain Tenosynovitis
References
Further Reading
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References

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  2. Brinker MR, Miller MD. The adult wrist. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:179-95.

  3. McGee DJ. Forearm, wrist, and hand. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:198-215.

  4. Snider RK. Hand and wrist. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:160-263.

  5. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.

  6. Ilyas AM, Ast M, Schaffer AA, et al. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. Dec 2007;15(12):757-64. [Medline].

  7. Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. Jan 2009;34(1):112-5. [Medline].

  8. Schned ES. DeQuervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. Sep 1986;68(3):411-4. [Medline].

  9. Forget N, Piotte F, Arsenault J, et al. Bilateral thumb's active range of motion and strength in de Quervain's disease: comparison with a normal sample. J Hand Ther. Jul-Sep 2008;21(3):276-84; quiz 285. [Medline].

  10. Batteson R, Hammond A, Burke F, et al. The de Quervain's screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care. Sep 2008;6(3):168-80. [Medline].

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  13. Diop AN, Ba-Diop S, Sane JC, et al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. J Radiol. Sep 2008;89(9 Pt 1):1081-4. [Medline].

  14. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  15. Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. Jan 2008;21(1):38-45. [Medline].

  16. Scheller A, Schuh R, Honle W, et al. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. Oct 2009;33(5):1301-3. [Medline].

  17. 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. Mar-Apr 2003;16(2):102-6. [Medline]. [Full Text].

  18. Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.

  19. Goldfarb CA, Gelberman RH, McKeon K, et al. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg [Am]. Dec 2007;32(10):1513-20. [Medline].

  20. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. Apr 2007;31(2):265-8. [Medline]. [Full Text].

  21. Apimonbutr P, Budhraja N. Suprafibrous injection with corticosteroid in de Quervain's disease. J Med Assoc Thai. Mar 2003;86(3):232-7. [Medline].

  22. Chodoroff G, Honet JC. Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection. Arch Phys Med Rehabil. Sep 1985;66(9):637-9. [Medline].

  23. Green SM. Nonsteroidal anti-inflammatories. In: Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:2000:11-2.

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Further Reading

Clinical guidelines:
Diagnostic imaging guideline for musculoskeletal complaints in adults - an evidence-based approach. Part 2: upper extremity disorders. Canadian Protective Chiropractic Association - Professional Association
l'Université du Québec à Trois-Rivières - Academic Institution. 2008 Jan. 31 pages. NGC:006702

Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Work Loss Data Institute - Public For Profit Organization. 2004 (revised 2008 May 29). 128 pages. NGC:006557

Clinical trials:
 A Clinical Trial of Splinting for DeQuervain's Tenosynovitis

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Keywords

de Quervain tenosynovitis, tenosynovitis, de Quervain's tenosynovitis, Quervain's tenosynovitis, quervain tenosynovitis, stenosing tenosynovitis, de Quervain's disease, Quervain disease, de Quervain disease, abductor pollicis, extensor pollicis, abductor pollicis longus, extensor pollicis brevis, pollicis longus, pollicis brevis

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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