Ultrasound-Guided Cortisone Injection for De Quervain’s Tenosynovitis

 

Introduction

De Quervain’s tenosynovitis is a condition that affects the tendons on the thumb side of the wrist. It is often associated with pain, swelling, and reduced movement, particularly when gripping or lifting objects. This condition is relatively common among those whose daily activities involve repetitive use of the hands and wrists, although it may develop without a clear cause.

At Alton Pain Clinic, clinicians offer ultrasound-guided cortisone injections as part of the treatment pathway for De Quervain’s tenosynovitis. Ultrasound guidance allows precise delivery of cortisone to the affected site, with the intention of reducing local irritation and improving tendon function.

This blog provides a detailed overview of De Quervain’s tenosynovitis, including anatomy, pathology, causes, symptoms, diagnosis, management options, and the role of ultrasound-guided cortisone injections.

Anatomy of the Wrist and Thumb

The wrist is made up of bones, ligaments, and tendons, each contributing to the fine balance between strength and mobility. On the thumb side of the wrist lies the first dorsal compartment, which houses two important tendons:

• Abductor pollicis longus (APL) — moves the thumb away from the palm.
• Extensor pollicis brevis (EPB) — extends the thumb at the knuckle.

Both tendons pass through a tunnel-like sheath lined with synovium, which reduces friction and allows smooth movement. The tunnel is supported by the extensor retinaculum, a fibrous band that keeps the tendons in place.

In De Quervain’s tenosynovitis, this smooth movement is disrupted. Swelling or thickening of the sheath narrows the tunnel, creating friction each time the thumb moves.

Pathology of De Quervain’s Tenosynovitis

The underlying problem in De Quervain’s is a mismatch between tendon movement and the space available within the sheath. Repetitive stress, microtrauma, or local changes in the sheath lining can lead to thickening and tightening of the fibro-osseous tunnel.

This restricts tendon movement, causing discomfort and functional limitation. While the term tenosynovitis implies inflammation, histological studies have shown that degenerative changes and fibrotic thickening may be more significant than active inflammation.

The clinical outcome, however, is the same — restricted gliding of the tendons, leading to pain, swelling, and functional impairment.

Causes and Risk Factors

Several factors are associated with De Quervain’s tenosynovitis, including:

• Repetitive activity — lifting, gripping, or twisting actions performed regularly.
• Childcare-related activities — lifting babies or toddlers, often referred to as “mother’s thumb.”
• Occupational use — manual labour, office work, or jobs requiring frequent wrist movement.
• Hobbies — sports such as tennis, or crafts such as knitting and gardening.

Risk factors also include:

• Gender — more common in women.
• Age group — typically affects people between 30 and 50 years.
• Pregnancy and postpartum changes — possibly due to hormonal influences and increased wrist use.
• Anatomical variations — some individuals have multiple tendon slips or compartments, predisposing them to irritation.

Symptoms

The symptoms of De Quervain’s tenosynovitis are distinctive and often localised:

• Pain along the thumb side of the wrist.
• Swelling or fullness at the base of the thumb.
• Discomfort that worsens with activities involving gripping, pinching, or lifting.
• Radiation of pain into the thumb or forearm.
• Reduced thumb movement and stiffness.

Daily tasks such as opening jars, writing, or holding a phone may become difficult due to pain and reduced grip strength.

Diagnosis

Diagnosis is based on a thorough clinical evaluation. Key aspects include:

• History — patients often describe gradual onset of pain linked to thumb use.
• Physical examination — clinicians check for swelling, tenderness, and restricted thumb movement.
• Finkelstein’s test — performed by asking the patient to make a fist with the thumb tucked inside, then moving the wrist towards the little finger. A sharp pain on the thumb side of the wrist indicates a positive test.

In selected cases, imaging may be used:

• Ultrasound — to visualise thickening of the tendon sheath, fluid, or multiple tendon slips.

Management Options

Interventional Measures

When symptoms do not settle, interventional options such as ultrasound-guided cortisone injections may be considered. These allow targeted delivery of medication to the affected tendon sheath with the aid of imaging.

Ultrasound-Guided Cortisone Injections at Alton Pain Clinic

At Alton Pain Clinic, clinicians perform cortisone injections under real-time ultrasound guidance. This ensures that the needle is directed with precision into the first dorsal compartment.

Ultrasound guidance offers several benefits:

• Visualisation of tendon anatomy.
• Identification of variations such as multiple tendon slips.
• Direct delivery of cortisone to the site of irritation.

This accuracy is especially important in the wrist, where structures are small and anatomically variable.

Cortisone: Mechanism of Action

Cortisone belongs to the corticosteroid group of medications. When injected locally into the tendon sheath, it may:

• Reduce local inflammatory activity by suppressing cellular mediators.
• Decrease thickening and swelling of the tendon sheath.
• Allow smoother gliding of tendons within the compartment.

By modulating the local environment, cortisone can reduce friction and irritation, potentially restoring mobility and function.

Role of the Clinician

The injection is performed by a clinician trained in musculoskeletal ultrasound. The clinician explains the procedure, positions the wrist appropriately, and guides the needle using real-time imaging to ensure accurate placement. Post-procedure monitoring is also part of the process.

Why Choose Alton Pain Clinic

Alton Pain Clinic provides a dedicated service for musculoskeletal conditions, combining clinical expertise with advanced ultrasound technology. The clinic’s approach to De Quervain’s tenosynovitis includes:

• A tailored assessment based on individual presentation.
• Ultrasound-guided procedures for precision and accuracy.
• Clinician-led care focused on the specific condition being treated.

Summary

De Quervain’s tenosynovitis is a painful condition involving the tendons of the thumb, often related to repetitive wrist use. It presents with local pain, swelling, and functional limitations that can affect everyday tasks.

Management typically begins with conservative measures, but when symptoms persist, ultrasound-guided cortisone injections may be considered. At Alton Pain Clinic, these are performed by clinicians using advanced ultrasound technology to deliver targeted treatment.

By understanding the anatomy, pathology, and mechanisms involved, ultrasound-guided cortisone injections form part of the structured management of De Quervain’s tenosynovitis.