non operative therapy

 

Is it mandatory to always undergo a surgery with a tendonitis (de Quervain disease)?

No! In the early stages of the disease (first weeks) the treatment is conservative. Ointments, as well as drugs can be useful in the very early stage. If this measures do not help, the next step can be a splint treatment or a treatment with oinment dressings, irradiation or injections.

Which ointments can be used for treatment of a tendonitis?

Oinments with an anti-inflammatory effects e.i  Diclofenac. Diclofenac is a cortisone free (non-steroidal) drug. Diclofenac blocks the production of the body’s own messengers, like e.g. Prostaglandin. Due to this blocking, the inflammatory reaction and subsequently the pain improves.

A transfer from Diclofenac through the skin into the blood is possible. Patients, which simultaneously use drugs for reducing the blood clotting or suffer from stomach or duodenal ulcers, should definetely talk to their physician about that.

Are there other options beside surgery or injection?

Yes. Especially if the disease is rather recent, the following proved:

regularly – means circa 5×5 minutes per day – move the hand in warm water.

Meanwhile flex and extend your fingers and the thumb – or just play with the hand in the warm water, like a child does.

Add curd soap, soft soap or Kamillosan to the pleasant warm water.

Drug treatment of tenosynovitis:

Which drugs are used for treating a tenosynovitis (de Quervain)?

Especially after the hand bath it’s useful to rub the region with Diclofenac. Let the ointment seep into the skin for about 5 minutes

With swellings and pain, the additional use of anti-rheumatism drugs like Diclofenac or Aspirn as should be considered.

I advise this drugs never without consultation of the primary physician, as those drugs have multiple side effects. (e.g. danger of stomach ulcers, change in blood clotting, worseing of bronchial asthma, …)

Cortisone injection for tenosynovitis de Quervain:

Often, the injection of a small amount of cortisone into the 1. Extensor tendon section is performed with the de Quervain disease.

The injection is not risk-free, too! Even if infections or damage at the extensor tendon of the thumb are rare.

Both, the cortisone related infection and the tearing of the extensor tendons are very severe complication, with a usually very less burdening measure.

If an injection or a surgery is the better way for individual cases, needs to be discussed with the trusted physician.

The illustration shows a cortisone injection at the thumb saddle joint.

The injection with the de Quervain’s disease is performed the same way about 2cm more into the direction of the body. (where the red arrow shows).

Only a small amount of the drug, contained in the shot is injected into the 1. extendor compartment (not into the extensor tendon)!

What effects are to be expected from a cortisone injection?

In some cases, the pain and the swelling disappears with a few days completely. In many cases, the therapy success is not of a lasting nature and the injection needs to be re-performed!

Not more than 3 injections should be performed, as the risk of damaging the extensor tendon of the thumb increases significantly!

immobilization for tenoynovits de Quervain:

Is an immobilization in a slint useful for treating a tendonitis (de Quervain)?

The spilnt is useful in case of very severe pain. The splint has an extra good effect if the mobility of the thumb is limited. (Illustration)

The splint-immobilization should be only performed short term in a severy pain phase of the tenosynovitis to avoid movement disorders.

A splint may never apply pressure, otherwise the symptoms are worseing!