Ultrasound-Guided Cortisone Injection for De Quervain’s Tenosynovitis

 

Introduction

De Quervain’s tenosynovitis is a condition affecting the tendons on the thumb side of the wrist. It is characterised by discomfort and functional limitation in the area, particularly during gripping, lifting, or movements that involve the thumb. The condition is relatively common among individuals who perform repetitive hand and wrist actions, but it may also occur without a clear cause.

At Joint Injections, clinicians utilise ultrasound-guided cortisone injections as part of the management pathway for De Quervain’s tenosynovitis. Ultrasound guidance allows precise localisation of the affected tendons, while cortisone may help reduce irritation in the region.

This blog explores De Quervain’s tenosynovitis in detail, from anatomy and pathology to diagnosis, management options, and the potential role of ultrasound-guided cortisone injections.

Anatomy of the Wrist and Thumb

The wrist is a complex structure composed of bones, ligaments, tendons, and soft tissues. On the thumb side of the wrist lies the first dorsal compartment, a fibro-osseous tunnel through which two important tendons pass:

  • Abductor pollicis longus (APL) — responsible for moving the thumb away from the hand.
  • Extensor pollicis brevis (EPB) — responsible for straightening the thumb at the knuckle.

These tendons are encased in synovial sheaths that allow them to glide smoothly within the compartment. The sheath and tunnel are supported by the extensor retinaculum, a fibrous band that holds the tendons close to the wrist.

Any disruption to this smooth gliding process, whether from swelling, thickening, or friction, may result in symptoms associated with De Quervain’s tenosynovitis.

Pathology of De Quervain’s Tenosynovitis

The term tenosynovitis refers to inflammation of the tendon sheath. In De Quervain’s, repetitive strain or microtrauma often leads to thickening of the tendon sheath and narrowing of the fibro-osseous tunnel.

This narrowing creates increased friction during tendon movement, producing discomfort, swelling, and impaired thumb mobility. Over time, this can lead to fibrotic changes in the sheath, perpetuating the cycle of irritation.

While traditionally described as an inflammatory condition, some studies have suggested that degenerative changes, rather than active inflammation, may play a role in its pathology. Regardless, the clinical presentation remains consistent.

Causes and Risk Factors

De Quervain’s tenosynovitis is commonly associated with activities that require repeated wrist and thumb movements. These may include:

  • Frequent lifting of infants or children (sometimes called “mother’s thumb”).
  • Occupational tasks involving repetitive wrist deviation, such as manual labour, assembly work, or prolonged typing.
  • Hobbies such as gardening, knitting, or racquet sports.

Other contributing factors may include:

  • Gender — it is more frequently observed in women.
  • Age — often seen in individuals between 30 and 50 years old.
  • Hormonal factors — pregnancy and postpartum changes may increase susceptibility.
  • Anatomical variations — some individuals may have multiple tendon slips or separate compartments, predisposing them to symptoms.

Symptoms

The clinical features of De Quervain’s tenosynovitis are typically localised to the thumb side of the wrist. Common symptoms include:

  • Pain and tenderness along the radial (thumb) side of the wrist.
  • Swelling or fullness in the region of the first dorsal compartment.
  • Discomfort aggravated by gripping, lifting, or twisting motions.
  • Pain radiating towards the thumb or up the forearm.
  • Stiffness and reduced range of motion of the thumb.

Many individuals also describe difficulty performing simple daily tasks, such as opening jars, writing, or holding objects.

Diagnosis

Diagnosis is largely clinical, based on history and examination. Clinicians may perform specific tests to reproduce symptoms, such as:

  • Finkelstein’s test — the patient makes a fist with the thumb tucked inside the fingers, followed by ulnar deviation of the wrist. Sharp pain along the thumb side of the wrist is considered a positive sign.
  • Eichhoff’s test — similar to Finkelstein’s, with slight variation in hand positioning.

Imaging may be used in selected cases:

  • Ultrasound — can demonstrate thickening of the tendon sheath, fluid accumulation, and anatomical variations.

Management Options

The management of De Quervain’s tenosynovitis involves a combination of conservative and interventional approaches, depending on symptom severity and response to initial treatments.

Conservative Measures

  • Rest and activity modification to reduce strain on the wrist.
  • Splinting of the thumb and wrist to restrict painful movements
  • Cold compresses to reduce discomfort.
  • Gentle stretching and strengthening exercises once acute symptoms subside.

Interventional Options

When symptoms persist, clinicians may recommend interventions such as ultrasound-guided cortisone injections. These are designed to deliver medication directly around the affected tendons with accuracy, potentially reducing local irritation.

Ultrasound-Guided Cortisone Injections at Joint Injections

At Joint Injections, cortisone injections are administered under real-time ultrasound guidance. This technique enables clinicians to:

  • Visualise the first dorsal compartment and its tendons.
  • Identify anatomical variations, such as multiple tendon slips.
  • Direct cortisone precisely to the affected site.

The use of ultrasound ensures accuracy, particularly important given the small and variable anatomy of the wrist.

Cortisone: Mechanism of Action

Cortisone belongs to a group of medications known as corticosteroids. When injected around tendons, it acts at a cellular level to:

  • Reduce activity of inflammatory mediators in the local tissue.
  • Diminish swelling of the tendon sheath.
  • Lessen friction within the fibro-osseous tunnel.

By modulating the inflammatory response, cortisone may allow the tendons to glide more freely, thereby improving mobility and function. The action is localised, as the injection targets the specific region of irritation.

Role of the Clinician

The procedure is performed by a trained clinician who uses ultrasound imaging to ensure accurate needle placement. The clinician also discusses the procedure with the patient, explains the process, and monitors the response following the injection.

Why Choose Joint Injections

Joint Injections focuses on precision and patient-centred care. By combining expertise with advanced ultrasound technology, the service is designed to provide targeted treatment for conditions such as De Quervain’s tenosynovitis.

The approach includes:

  • Individualised assessment of symptoms.
  • Use of real-time ultrasound to enhance accuracy.
  • Clinician-led treatment tailored to the condition.

Summary

De Quervain’s tenosynovitis is a condition of the tendons on the thumb side of the wrist, often linked to repetitive use and overstrain. It presents with localised pain, swelling, and difficulty performing daily tasks.

Management begins with conservative strategies, but in cases where symptoms persist, ultrasound-guided cortisone injections may be considered as part of the treatment pathway. At Joint Injections, these procedures are carried out by clinicians with the aid of ultrasound, ensuring precision in delivery.

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