Intra sheath corticosteroid injection for De Quervain’s tenosynovitis


  • Shanmuga Sundaram Pooswamy Department of Orthopaedics, Saveetha Medical College Hospital, Tamil Nadu, India
  • Niranjanan Raghavn Muralidharagopalan Department of Orthopaedics, Saveetha Medical College Hospital, Tamil Nadu, India



De Quervain, Steroid injection, Intra sheath triamcinolone, Failed conservative


Background: De Quervain’s disease or stenosing tenosynovitis of the first dorsal compartment of the wrist is a common condition, which affects the Abductor pollicis longus and the extensor pollicis brevis tendons. There are characteristic signs and symptoms including a positive Finkelstein's test. Different options for treatment include conservative approaches like analgesics, splinting and physical therapy. If conservative options fail then steroid injection is considered.

Methods: This is a retrospective study of single dose intra-sheath triamcinolone and lignocaine injection in 32 patients at our institute who were followed up for a period of 12 months.

Results: In our study there were 25 females and 7 males with a mean age of 46.4±8.03 years. Right side was involved in 17 patients and left side in 15 patients. The pre procedure VAS score was 8.65±1.07. The follow up VAS scores at 1, 6 and 12 months respectively were 1.4±1.14, 0.84±1.06 and 1.03±1.26 respectively. 4 out of 32 patients had positive Finkelstein’s test at 1 year follow up. Common complications were pain at injection site, which was seen in 5/32 patients and depigmentation seen in 2/32 patients.

Conclusions: Thus intra sheath triamcinolone injection is a safe and effective procedure for treatment of De Quervains disease.

Author Biography

Niranjanan Raghavn Muralidharagopalan, Department of Orthopaedics, Saveetha Medical College Hospital, Tamil Nadu, India

Associate professor, 

Department of Orthopaedics 

Saveetha Medical College



De Quervain’s F. On the nature and treatment of stenosing tendovaginitis on the styloid process of the radius. J Hand Surg [Br]. 2005;30:392-4.

De Quervain F. On a form of chronic tendovaginitis. (Translated article: Cor-Bl.f.schweiz. Aerzrte 1895:25:389-94). J Hand Surg [Br]. 2005;30:388-91.

Moore JS. De Quervain's tenosynovitis. Stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med. 1997;39:990-1002.

Schned ES. De Quervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. 1986;68:411–894.

Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain’s disease. J Hand Surg Am. 1994;19:595-8.

Clarke MT, Lyall HA, Grant JW, Matthewson MH. The histopathology of de Quervain's disease. J Hand Surg [Br]. 1998;23(6):732-4.

Palmer K, Walker-Bone K, Linaker C, Reading I, Kellingray S, Coggon D, et al. The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb. Ann Rheum Dis. 2000;59:5-11.

Richie CA, Eriner WW Jr. Corticosteroid injection for treatment of de Quervain's tenosynovitis:a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16:102-6.

Ta KT, Eidelman D, Thomson JG. Patient satisfaction and outcomes of surgery for de Quervain's tenosynovitis. J Hand Surg Am. 1999;24:1071-7.

Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1):87-101.

Ilyas AM, Ast M, Schaffer AA. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15:757–64.

Kitti JI, Sukit S, Kitiwan V, Surut JI. Treatment of De Quervain disease with triamcinolone injection with or without nimesulide. J Bone Joint Surg Am. 2004;86:2700–6.

Froimson A. Tenosynovitis and tennis elbow. In:Green DP (ed) Operative hand surgery, vol. 2, 3rd edn. New York: Churchill Living- stone; 1993: 1989–2006.

Quinnel RC. Conservative management of trigger finger. Practitioner. 1980;224:187–90.

Anderson BC, Manthey R, Brouns MC. Treatment of De Quervain’s tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum. 1991;34:793–8.

Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg [Am]. 2002;27:322-4.

McDermott JD, Ilyas AM, Nazarian LN, Leinberry CF. Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res. 2012;470(7):1925-31.

Kamel M, Moghazy K, Eid H, Mansou R. Ultrasonographic diagnosis of de Quervain’s tenosynovitis. Ann Rheum Dis. 2002;61:1034-5.

Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease. Skelet Radiol. 2009;38:1099-103.

Goldfarb CA, Gelberman RH, McKeon K, Chia B, Boyer MI. Extra-articular steroid injection:early patient response and the incidence of are reaction. J Hand Surg Am. 2007;32:1513–20.

Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990;15:83-7.

Jackson WT, Viegas SF, Coon TM. Anatomical variation in the First extensor compartment of the wrist:a clinical and anatomical study. J Bone Joint Surg Am. 1986;68:923–6.

Sawaizumi T, Nanno M, Hiromoto IT. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31(2):265-8.

Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. 2011;39(2):398-403.






Original Research Articles