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 of hand, including abductor pollicis longus (APL) and extensor pollicis brevis (EPB) 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 disk throwing. According to a 2009 report, risk factors include the following [4] :
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Female sex
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Age over 40 years
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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. [6]
Indications
Thumb injection is indicated for the treatment of de Quervain tenosynovitis. Corticosteroid injections may be effective in as many as 80% of cases involving this condition. [7]
Thumb injection is sometimes performed for osteoarthritis of the thumb base. [8, 9] In addition to corticosteroids, hyaluronic acid [10] and platelet-rich plasma (PRP) [11] have been employed. A randomized controlled trial by Winter et al (N = 95; mean follow-up, 2 y) found that in patients with trapeziometacarpal osteoarthritis, injection of a combination of autologous fat and PRP into the thumb saddle joint yielded an improvement in hand function and a corresponding improvement in quality of life. [12]
Contraindications
Contraindications for thumb injection include local infection and allergy to the chosen anesthetic or corticosteroid.
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First dorsal compartment of hand, including abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
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Thumb injection: equipment (corticosteroid, anesthetic).
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Corticosteroid injection into thumb for de Quervain tenosynovitis.
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Right trigger thumb injection. Video courtesy of James R Verheyden, MD.
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Separate right trigger thumb injection. Video courtesy of James R Verheyden, MD.
