Analgesia for de Quervain tenosynovitis

Note: Local corticosteroid injection is very effective for relieving pain in de Quervain tenosynovitis, has effects for about 6 weeks and can be used in people who are pregnant or breastfeeding.

Local corticosteroid injection is very effective for relieving pain in de Quervain tenosynovitisCurrie, 2022Allbrook, 2019Oh, 2017 and is more effective than nonsteroidal anti-inflammatory drugs (NSAIDs) or splinting. If available, local corticosteroid injection is the first-line treatment and can be repeated if symptoms recur. The corticosteroid should be injected into the tendon sheath along the radial aspect of the wrist. A clinician experienced with soft-tissue injections is usually required because the space between a tendon and its sheath is very small. Alternatively, injection can be performed under radiological guidance (eg ultrasound-guidance). See Principles of using local corticosteroid injections for musculoskeletal pain for more details on dosing. Local corticosteroid injection can be used in people who are pregnant or breastfeeding.

Oral analgesics are often not very effective for de Quervain tenosynovitis; however, a trial of simple analgesia (such as paracetamol or NSAID) is reasonable initially; see drug recommendations in Analgesia for acute soft-tissue limb conditions. NSAIDs may provide pain relief but should be avoided in pregnancy and must be avoided after 30 weeks’ gestation. For advice on the use of NSAIDs in people who are pregnant or breastfeeding, see Potential harms of NSAID use during pregnancy and NSAID use in people who are breastfeeding.

Note: In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks’ gestation.