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
Please see Medication.
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.
Complications
Please see Other Treatment, which includes a discussion of potential complications of corticosteroid injections.
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.
A literature review by Cavaleri et al indicated that the combined use of orthoses and corticosteroid injections for de Quervain tenosynovitis is more effective at improving pain and function than the use of either treatment by itself. [49]
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.
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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.
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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.
