Thumb Injection

Updated: Oct 27, 2017
  • Author: Charlene Kiang, MD; Chief Editor: Erik D Schraga, MD  more...
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Overview

Background

De Quervain tenosynovitis was first described by Swiss physician Fritz de Quervain, in 1895, in a series of case reports. [1, 2]  This common condition is caused by inflammation of the tendons in the first dorsal compartment of the wrist. The tendons involved are the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons (see the image below). [3]

First dorsal compartment, including the abductor p First dorsal compartment, including the abductor pollicis longus and extensor pollicis brevis tendons.

Repetitive radial and ulnar deviation of the wrist, associated with flexion of the thumb, causes thickening of the tendon sheath and pain when the inflamed tendons cross the distal radial styloid.

Patients who report these symptoms often have occupations that involve repetitive gripping and grasping with the thumb or pastimes such as racquet sports, golf, or disc throwing. According to a 2009 report, risk factors include the following [4] :

  • Female sex
  • Age over 40 years
  • Black race

Physical examination is significant for tenderness at the distal radial styloid. [5]  The Finkelstein test is positive in these patients—that is, pain is elicited when the patient makes a fist with the thumb tucked in and the wrist is rotated in the ulnar direction. Steroid injection is efficacious when standard conservative treatment fails.

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Indications

Thumb injection is indicated for the treatment of de Quervain tenosynovitis.

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Contraindications

Contraindications for thumb injection include local infection and allergy to the chosen anesthetic or corticosteroid.

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