Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm

Abstract

Background: Nonsurgical management of de Quervain disease relies mainly on the use of oral nonsteroidal antiinflammatory drug administration, splint therapy, and corticosteroid injections. Although the latter is most effective, with documented success rates of 61 to 83 percent, there exists no clear consensus pertaining to conservative treatment protocols conferring the best outcomes. This article reports on all present conservative treatment modalities in use for the management of de Quervain disease and highlights specific treatment- and patient-related factors associated with the best outcomes. Methods: A systematic search was performed using the PubMed database using appropriate search terms; two independent reviewers evaluated retrieved articles using strict inclusion and exclusion criteria. Results: A total of 66 articles met the inclusion criteria for review, consisting of 22 articles reporting on outcomes following a single conservative treatment modality, eight articles reporting on combined treatment approaches, 13 articles directly comparing different conservative treatment regimens, and 23 case reports. Conclusions: A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation. Although there exists some evidence showing that multipoint injection techniques and multiple injections before surgical referral may provide benefit over a single point injection technique and a single injection before surgery, corticosteroid use is not benign and should thus be performed with caution. Ultrasound was proven valuable in the visualization of an intercompartmental septum, and ultrasound-guided injections were shown to both be more accurate and confer better outcomes. Several prior and concurrent medical conditions may affect conservative treatment outcome. A Level I to II evidence-based treatment protocol is recommended for the optimal nonsurgical management of de Quervain disease.

Quervain's Tenosynovitis, General Description

“…Non-surgical treatment of Quervain's disease is a good option, in which oral non-steroidal anti-inflammatory drugs can be given, accompanied by immobilization and, if necessary, corticosteroid injections. Treatment with the latter has been very successful with rates of 61 to 83 percent (9).…”

“…Multi-point injection procedures and multiple injections prior to surgical resolution usually provide greater benefit compared to a single point injection technique or a single injection prior to surgery. Also the use of splints and corticosteroid injections together as a treatment often provides more benefit than when used individually (9).…”

Clinical Implications and Treatment Algorithm for Patients with de Quervain’s Tenosynovitis

“…Additionally, to assess the patient's improvement, the treating orthopaedic surgeon will subjectively evaluate the patient's ability to return to their normal activities of daily living. For instance, can the patient pick up a cup of coffee or their child without pain [21][22][23][24].…”

Management of de Quervain Tenosynovitis

“…As with many orthopaedic conditions, nonoperative management is the first-line treatment. Corticosteroid injections (CSIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and immobilization are the most common nonoperative modalities for DQT 11 . However, an exact treatment protocol for nonoperative management of DQT has yet to be defined.…”