Physical Medicine and Rehabilitation for De Quervain Tenosynovitis Follow-up

  • Author: Patrick M Foye, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Nov 2, 2010
 

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.

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Inpatient & Outpatient Medications

Please see Medication.

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Deterrence

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

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Complications

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

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Prognosis

Most patients with de Quervain 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.

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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.

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  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 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.

Dev Sinha, MD  Research Associate/Physiatrist Observership, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Kelly L Allen, MD  Medical Director, Medevals

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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The first dorsal compartment of the wrist includes the tendon sheath that encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomic snuffbox.
The Finkelstein test is performed by having the patient make a fist with the thumb inside the fingers. The clinician then applies ulnar deviation of the wrist to reproduce the presenting symptoms of dorsolateral wrist pain.
 
 
 
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