De Quervain’s tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. It develops when the two main thumb tendons, the abductor pollicis longus and the extensor pollicis brevis, become irritated and swell within the narrow tunnel, or sheath, they pass through near the wrist bone. This swelling creates friction, leading to pain and tenderness that is often worsened by grasping, gripping, or twisting the wrist. De Quervain’s tenosynovitis generally does resolve, but it almost always requires some form of medical intervention.
The Timeline of Resolution
While the condition can be a short-term issue, it is unlikely to resolve completely without taking action to reduce the tendon irritation. When left unaddressed, the pain tends to become chronic, and the thickening of the tendon sheath can worsen, making later treatment more challenging. Early diagnosis is important because treatment started sooner has a better chance of leading to a speedy recovery.
With effective conservative treatment, symptoms often improve significantly within four to six weeks. Recovery typically ranges from a few weeks to a few months, depending on the severity and the promptness of the intervention. Factors that can prolong recovery include continued repetitive movements that caused the irritation, such as certain occupational tasks or hobbies, or underlying inflammatory conditions.
Primary Non-Surgical Management
The goal of initial treatment is to reduce the swelling and irritation of the tendons, allowing them to glide smoothly through their sheath again. One of the first steps involves activity modification, meaning the avoidance of specific repetitive motions that trigger the pain. This rest gives the irritated tissues a chance to heal naturally.
Immobilization is often achieved using a device called a thumb spica splint, which holds the wrist and thumb still to relieve pressure on the tendons. This splint is typically worn for several weeks to ensure the tendons are adequately rested. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to help manage pain and reduce localized swelling.
The most effective non-surgical treatment is a corticosteroid injection administered directly into the tendon sheath. The steroid acts as an anti-inflammatory agent, quickly shrinking the swollen tissue and relieving the pressure on the tendons. A single injection is highly successful, providing complete relief for an estimated 50% to 80% of patients, especially when performed early. For those who do not respond fully, a second injection may be considered.
Advanced and Surgical Interventions
If primary management, including corticosteroid injections, does not successfully resolve the symptoms, a more advanced approach is necessary. Physical therapy and occupational therapy often become involved at this stage to introduce gentle stretching and strengthening exercises. Therapists also help patients identify and modify daily activities to reduce strain on the affected wrist and thumb.
When all conservative treatments fail, surgical intervention is considered the final option for chronic cases. The procedure, known as De Quervain’s release, is an outpatient surgery performed to open the tight fibrous sheath surrounding the tendons. The surgeon makes a small incision at the base of the thumb to cut the sheath, creating more space for the tendons to glide without friction.
Recovery from surgery typically involves a period of rest, sometimes with a splint, followed by rehabilitation exercises. While the initial pain and swelling subside quickly, regaining full strength and mobility often takes about six to eight weeks.