De Quervain's Tenosynovitis Injection

Aka: De Quervain's Tenosynovitis Injection, De Quervain Injection, Abductor Pollicis Longus Sheath Injection

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II. Indications

  1. De Quervain's Tenosynovitis

III. Efficacy

  1. Curative in 83% of cases (contrast with 14% with Splinting and 0% with NSAIDs aone)
    1. Richie (2003) J Am Board Fam Pract 16(2): 102-6 [PubMed]

IV. Safety

  1. Safe during pregnancy, postpartum and in Lactation
    1. Avci (2002) J Hand Surg 27(2): 322-4 [PubMed]

V. Preparation

  1. Needle: 27 gauge (1.5 inch)
  2. Corticosteroid
    1. Methylprednisolone: 20-40 mg or
    2. Celestone Soluspan: 1 ml
    3. Triamcinolone 20-40 mg or
  3. Anesthetic
    1. Lidocaine 1%: 2 ml or
    2. Bupivacaine (Marcaine) 0.25% 2 ml

VI. Technique

  1. Images
    1. OrthoWristDequervains.jpg
  2. Wrist and hand position
    1. Maximally abduct thumb (accentuates abductor tendon)
  3. Injection site
    1. Snuffbox at base of thumb
    2. Between two tendons in dorsal wrist compartment 1
      1. Abductor pollicis longus
      2. Extensor pollicis brevis
  4. Needle insertion
    1. Apply antiseptic to skin (e.g. Betadine)
    2. Aim 30-45 degrees proximally toward radial styloid
    3. Insert needle between the 2 tendons (not in tendon)
    4. Do not inject if Paresthesias (see below)
  5. Ultrasound Guidance (optional)
    1. High frequency linear probe placed in transverse position (short axis, horizontal) overlying the landmark
    2. With hand in slight ulnar deviation, the needle is inserted in-plane from dorsal aspect
  6. Precautions
    1. Do not inject directly into tendon
    2. Distal Paresthesias with needle before steroid
      1. Indicates needle at sensory branch of Radial Nerve
      2. Do not inject here!
      3. Withdraw and redirect needle 2-3 mm to either side

VII. Management: Follow-up

  1. Consider Splinting after injection
  2. May be repeated up to 1-2 times at 7-14 day intervals

VIII. References

  1. Greene (2001) Musculoskeletal Care, p. 234
  2. Neustadt in Roberts (1998) Procedures, p. 914-5
  3. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  4. Pujalte (2024) Am Fam Physician 110(4): 402-10 [PubMed]
  5. Tallia (2003) Am Fam Physician 67(4):745-50 [PubMed]

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