Which is better for DeQuervain's : SPLINTING OR INJECTION?

​DeQuervain's tenosynovitis

DeQuervains' is a common cause of wrist and thumb pain in the community. Traditionally you may have heard about it occurring in new mothers due to the sudden change in demands associated with caring for young children. But it can affect people of any age, who is involved in repetitive wrist and thumb movements through work,  DIY, new hobbies, sports, or even moving house.
​

​So what is Dequervain's anyway?

Inflammation of the tendons that lift your thumb out and away from the hand occurs when there is a sudden increase in use. Once the tendons are swollen, they rub on the undersurface of the anchor strap around your wrist when you move your wrist and thumb causing the inflammation to be maintained or aggravated.

This could be due to COVID lockdown knitting, a deadline at work or simply breastfeeding your new baby.
​

​What treatments can help DeQuervain's?

​
The good news is the it can be managed without surgery in the majority of cases. Management typically involves:

1) avoiding aggravation through ergonomic changes,
2) resting the inflamed tendons with splinting
3) restoring flexibility and strength with exercises to ensure the issue does not recur
4) soft tissue massage
5) icing/ oral anti-inflammatory medications can also be helpful

​What exactly does a cortisone injection (CSI) do?

​
Cortisone injections use a needle to deliver anti-inflammatory medication directly to the swollen tendon (inside its sheath) to reduce swelling. This is commonly done under the guidance of an ultrasound scan.

In more chronic cases the injection will also help to break down adhesive scar tissue which causes stiffness. However many people notice the 'effects wearing off' after about 6-8 weeks as the medication gets broken down in your body.

​So which treatment should you try first?

​
Studies are ongoing and certainly indicate an improvement through either splinting or cortisone injection. So you can make a good argument for choosing either as an initial management strategy.

Although Physiotherapists can refer for ultrasound scans we cannot give you a referral for the CSI so you would need to discuss this choice with your GP or specialist if you wanted to start with the injection option.

Sadly however I do see many patients commencing  hand therapy after having had only temporary relief from their 1st (or second) cortisone injection. The majority of these cases can still be helped without needing to resort to surgery.

So what do I recommend to my patients?

There are many factors to be considered including the client's level of patience, tolerance to wearing splints and attitude to injections. Some people are very comfortable with injections and others would prefer less invasive management.

Certainly being educated by your local hand therapist to ensure that you address the underlying cause of the inflammation so that the problem does not recur is a good idea no matter which management path you decide to start with. 

​

Book Now