De Quervain's Tenosynovitis Injection

About this injection

De Quervain's tenosynovitis is inflammation of the tendons on the thumb side of the wrist — specifically the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons as they pass through the first dorsal compartment at the radial styloid.

It causes pain and swelling at the base of the thumb and radial wrist, typically worse with thumb and wrist movement. It is particularly common in new mothers (due to repetitive lifting of infants), and in people with occupations or hobbies involving repetitive thumb and wrist use.

Corticosteroid injection into the first dorsal compartment is the most effective non-surgical treatment, with success rates of 70–90%. Dr Hasham performs the injection using anatomical landmark technique, targeting the tendon sheath directly at the radial styloid.

Conditions treated

• ✓De Quervain's tenosynovitis — the primary indication
• ✓Radial wrist pain in new mothers ("washerwoman's sprain")
• ✓Occupational or sport-related repetitive thumb strain
• ✓Post-partum De Quervain's — extremely common in breastfeeding mothers

Symptoms

• —Pain and tenderness at the radial side of the wrist and base of the thumb
• —Swelling over the radial styloid
• —Pain on gripping, pinching, and twisting movements
• —Pain worse when lifting with the wrist in ulnar deviation (lifting a baby)
• —Creaking sensation over the radial styloid
• —Finkelstein's test positive — positive test is highly diagnostic

Assessment & diagnosis

Finkelstein's test is the key diagnostic manoeuvre — the thumb is enclosed in the fist and the wrist ulnar-deviated, reproducing the pain. Tenderness is maximal over the first dorsal compartment at the radial styloid. The test is highly sensitive and specific for De Quervain's.

Treatment options

What happens on the day

1. Finkelstein's test to confirm diagnosis
2. Point of maximum tenderness at the first dorsal compartment identified
3. Wrist positioned with thumb pointing upward (radial styloid accessible)
4. Skin cleaned with antiseptic
5. Needle inserted tangentially into the first dorsal compartment tendon sheath
6. Correct placement confirmed — fluid tracks along the sheath ("sausage sign") without resistance
7. Corticosteroid and local anaesthetic injected
8. Needle withdrawn, dressing applied

Injection technique

The needle is inserted at the radial styloid, angled proximally at a shallow angle, entering the first dorsal compartment tendon sheath between the APL and EPB tendons. Correct intra-sheath placement produces a visible 'sausage' of fluid tracking along the tendon. Resistance suggests the needle tip is in the tendon — reposition slightly. Triamcinolone 20mg or methylprednisolone 20–40mg in 1–2ml local anaesthetic is used.

Risks & side effects

• —Post-injection flare — 24–48 hours of increased pain, then improvement
• —Skin depigmentation and fat atrophy at the wrist — more common with multiple injections at a superficial site
• —Radial nerve sensory branch injury — rare with careful technique
• —Tendon weakening — avoid injecting into the tendon substance
• —Infection — rare

Aftercare

• ✓Rest the wrist and thumb for 48 hours after injection
• ✓A thumb spica splint for 2–4 weeks improves outcomes
• ✓Avoid repetitive thumb and wrist movements during recovery
• ✓Effect builds over 1–2 weeks
• ✓If no improvement after 6 weeks, a second injection or surgical release should be considered

Frequently asked questions