De Quervain's Tenosynovitis Treatment London | Private Ultrasound Diagnosis & Injections

De Quervain's Tenosynovitis Explained

Thumb Tendon Anatomy

De Quervain’s tenosynovitis is the medical term for inflammation of the tendon sheath of the first dorsal tendon compartment of the wrist.

There are six dorsal tendon compartments in the wrist. Each compartment contains tendons that provide anchorage from the outer forearm muscles to the hand and fingers — and in the case of the first dorsal compartment, to the thumb.

The first dorsal compartment is located immediately adjacent to the thumb, at the bony landmark of the distal radius, which can be palpated. This area is typically painful to touch in an individual with De Quervain’s tenosynovitis.

De Quervain's Tenosynovitis Symptoms

The symptoms of De Quervain’s tenosynovitis are significant and focal pain over the thumb side of the wrist which may travel up to the forearm or down into the thumb itself. 

Typically, activities which involve lifting and carrying with the thumb uppermost cause significant aggravation as these activities load the tendons of the first dorsal wrist compartment and, therefore, irritate the tendon sheath which is the underlying inflamed tissue.

What Causes De Quervain's Tenosynovitis?

De Quervain’s tenosynovitis is a common condition encountered in clinical practice. It is far more prevalent in postpartum women, due to a combination of:

• Hormonal changes, which make tissues more susceptible to inflammation.

• Repetitive mechanical strain on the thumb tendons caused by cradling and lifting a newborn infant — an activity that places exaggerated load on the first dorsal compartment tendons.

Diagnosing De Quervain's Tenosynovitis

De Quervain’s tenosynovitis can be reliably diagnosed by a history of the condition and a physical examination. 

Prior to treatment the gold standard imaging modality for confirming the diagnosis is an ultrasound scan due to the superficial nature of the structures involved ie the first dorsal compartment tendon sheath and abductor pollicis longus and extensor pollicis brevis tendons. 

An ultrasound can also reliably diagnose other possible structures to cause the pain in the radial aspect of the wrist and thumb regions such as the first carpometacarpal joint.

De Quervain's Tenosynovitis Ultrasound Guided Injection

How is a De Quervain's Tenosynovitis injection administered?

When encountered in clinical practice, De Quervain’s tenosynovitis can sometimes be managed with a six-week trial of a soft tissue brace, to allow the tendon sheath to settle.

However, this approach may not be practical for new mothers or individuals needing to return quickly to normal function. In such cases, a more practical and efficient solution is to provide an ultrasound-guided injection to the first dorsal tendon compartment.

This ultrasound-guided injection is performed with the wrist positioned thumb-up. The ultrasound probe is placed in a longitudinal orientation, with the distal end pointing towards the tip of the thumb and the proximal end pointing towards the elbow.

A small amount of stand-off gel is placed at the distal end of the probe to allow visualisation of the needle prior to skin entry. This aids in accurately targeting the interface between the inflamed tendon sheath and the tendon bodies.

The needle is then visualised passing from distal to proximal, advancing within the interface between the tendons and tendon sheath, with the injectate clearly seen flowing into the compartment.

What to Do After Your De Quervain's Tenosynovitis Injection

Needle Path & Post-Injection Pain
The tendons of the 1st dorsal wrist compartment are superficial and as such no significant needle trauma is caused during an ultrasound guided injection for De Quervain's Tenosynovitis. In some cases the steroid medication may react with the inflamed tendon sheath or the subcutaneous tissues which may cause a 2-3 day post injection flare of pain. Using a thumb or wrist brace over this period of time with use of over-the-counter painkillers (as directed on the patient information leaflet) may be taken if safe.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
After a De Quervain's injection, it is advisable to avoid any significant increase in activity for 10 days and during this time using a thumb or wrist brace may be beneficial.
This allows the anti-inflammatory properties of the steroid to work optimally.
Following this period, you should engage in a progressive program of physical therapy exercises but should not push the wrist into pain.

Follow-Up
Following an De Quervain's injection, please contact me immediately if you experience any difficulties.

Other Treatments for De Quervain's Tenosynovitis

De Quervain's Tenosynovitis Thumb Immobilisation

Physical Therapy exercises for De Quervain's Tenosynovitis

De Quervain's Tenosynovitis | Evidence base

De Quervain’s tenosynovitis is an overuse condition involving stenosing tenosynovitis of the first dorsal compartment, affecting the abductor pollicis longus and extensor pollicis brevis tendons. It presents with radial wrist pain, tenderness, and pain with thumb movement or gripping. While some mild cases may settle with activity modification and splinting, evidence strongly supports corticosteroid injection into the first dorsal compartment as the most effective non-surgical treatment, with high rates of symptom resolution. Ultrasound guidance improves injection accuracy and is particularly valuable given the frequent anatomical variation within the first dorsal compartment, including septation between tendon slips, which is a known cause of failed landmark-guided injections. Studies suggest US-guided injections are associated with higher success rates, faster symptom improvement, and lower recurrence, especially in patients with persistent symptoms, postpartum onset, or prior failed injections. Most patients respond to a single injection; a second injection may be considered if symptoms recur, though repeated injections should be limited. Surgical release is reserved for refractory cases after failed injection therapy. Overall, ultrasound-guided corticosteroid injection is a highly effective, low-risk first-line intervention for De Quervain’s tenosynovitis and facilitates rapid return to function.

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