Ultrasound-Guided Cortisone Injections for De Quervain’s Tenosynovitis

 De Quervain’s tenosynovitis is a painful condition affecting the tendons in the wrist and thumb. At Alton Pain Clinic, we specialise in advanced treatments, including ultrasound-guided cortisone injections, to manage conditions like De Quervain’s tenosynovitis effectively and with precision. This blog explores everything you need to know about the condition, its causes, symptoms, and the role of cortisone injections in its management.

De Quervain’s tenosynovitis

Understanding De Quervain’s Tenosynovitis

Definition
De Quervain’s tenosynovitis is the inflammation of the tendons that run along the thumb’s side of the wrist. These tendons are housed in a sheath that helps them glide smoothly during thumb and wrist movement. Inflammation of the sheath can lead to pain, swelling, and restricted movement.

Prevalence
This condition is common among individuals who engage in repetitive hand or wrist activities, such as typing, gardening, or lifting. It is also frequently observed in new parents due to repetitive lifting of their children.

Anatomy of the Wrist and Thumb

Tendons Involved
The condition affects two primary tendons in the thumb:

  1. Abductor Pollicis Longus (APL): Responsible for moving the thumb away from the hand.
  2. Extensor Pollicis Brevis (EPB): Helps extend the thumb at the base joint.

These tendons pass through a fibrous sheath at the wrist, ensuring smooth movement.

Anatomical Structures

  • Tendon Sheath: A protective layer surrounding the tendons to reduce friction during movement.
  • First Dorsal Compartment: A tunnel in the wrist where these tendons pass. Narrowing of this space can lead to inflammation.

Causes and Risk Factors

Repetitive Movements
Activities requiring repetitive thumb and wrist motions can irritate the tendons, leading to inflammation.

Pregnancy and Postpartum Period
Hormonal changes and repetitive lifting of infants often contribute to the onset of this condition.

Other Risk Factors

  • Arthritis or other inflammatory conditions.
  • Trauma or injury to the wrist.
  • Occupations requiring constant gripping or twisting motions.

Symptoms of De Quervain’s Tenosynovitis

Pain and Swelling
The most prominent symptom is pain on the thumb side of the wrist, often accompanied by swelling.

Difficulty Moving the Thumb
Activities like gripping, pinching, or twisting can become challenging due to pain and stiffness.

Crepitus
In severe cases, a creaking sensation may occur as the tendons move through the inflamed sheath.

Radiating Pain
The pain may extend into the thumb or forearm, impacting daily activities.

Diagnosis of De Quervain’s Tenosynovitis

Physical Examination
Healthcare professionals often use the Finkelstein test to diagnose the condition. This involves bending the thumb across the palm and flexing the wrist towards the little finger to elicit pain.

Imaging Tests

  • Ultrasound: A non-invasive imaging tool used to visualise inflammation, fluid accumulation, or tendon thickening.
  • MRI: Occasionally used for detailed imaging in complex cases.

Pathology of De Quervain’s Tenosynovitis

Inflammatory Response
Repetitive use or injury leads to inflammation of the tendons and their sheath. This inflammation can thicken the sheath, restricting tendon movement and causing pain.

Fibrosis
Chronic cases may involve scar tissue formation, further narrowing the tendon sheath and exacerbating symptoms.

Conservative Management Options

Before considering injections, many patients respond to non-invasive treatments:

  1. Activity Modification: Reducing activities that strain the wrist and thumb.
  2. Splinting: Immobilising the wrist and thumb to allow the tendons to rest and heal.
  3. Physical Therapy: Stretching and strengthening exercises prescribed by physical therapists can reduce symptoms and prevent recurrence.
  4. Anti-Inflammatory Medication: Oral or topical medications to reduce swelling and pain.

Ultrasound-Guided Cortisone Injections

What Are Cortisone Injections?
Cortisone injections combine corticosteroids (powerful anti-inflammatory agents) with a local anaesthetic to provide pain relief and reduce inflammation.

Role of Ultrasound Guidance
At Alton Pain Clinic, we use ultrasound imaging to precisely locate the affected area. This ensures that the medication is delivered directly to the site of inflammation, maximising effectiveness and minimising side effects.

Mechanism of Action

Reducing Inflammation
Corticosteroids suppress the immune response that causes inflammation in the tendon sheath. This reduces swelling and alleviates pain.

Immediate Pain Relief
The local anaesthetic provides temporary but immediate relief by numbing the area around the injection site.

Long-Term Relief
While the local anaesthetic offers instant pain relief, the corticosteroid takes a few days to work and provides long-term symptom relief lasting weeks or months.

Procedure for Cortisone Injections

Pre-Injection Preparation
The skin around the injection site is cleaned to reduce infection risk.

Ultrasound Guidance
The clinician uses real-time imaging to position the epidural needle precisely. This ensures the medication is injected directly around the inflamed tendons.

Injection
The doctor injects the medication, ensuring minimal discomfort and maximum precision.

Post-Procedure Instructions
Patients are advised to rest the wrist for a few days and avoid strenuous activities to allow the medication to take full effect.

Benefits of Cortisone Injections

  1. Precise Treatment: Ultrasound guidance ensures accurate delivery of medication.
  2. Non-Surgical Option: Offers relief without the risks associated with surgery.
  3. Quick Recovery: Most patients resume normal activities within days.
  4. Effective Pain Management: Reduces pain and inflammation, improving mobility.

Limitations and Risks

Temporary Relief
While effective, the results may last from weeks to a few months, requiring repeat injections for long-term management.

Side Effects
Potential side effects include:

  • Localised swelling or redness at the injection site.
  • Temporary flare-up of symptoms.
  • Rarely, weakening of nearby tendons.

Cortisone Injections vs Other Treatments

Compared to Surgery

Compared to Medications

  • Oral anti-inflammatory drugs can have systemic side effects, while cortisone injections target the specific area of inflammation.

Long-Term Management

Preventative Measures

  • Avoid repetitive wrist motions.
  • Use ergonomic tools and wrist supports during activities.

Follow-Up Care
Regular check-ups at Alton Pain Clinic ensure the condition is managed effectively and recurrences are minimised.

When to Consider Surgery

If symptoms persist despite conservative treatments and injections, surgery may be necessary to release the tendon sheath and relieve pressure.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we prioritise patient-centred care and use the latest techniques, including ultrasound-guided injections, to ensure effective and precise treatment. Our experienced team is committed to helping you regain mobility and reduce pain with tailored treatment plans.

Conclusion

De Quervain’s tenosynovitis can significantly impact daily life, but effective treatments are available. Ultrasound-guided cortisone injections offer a precise, minimally invasive solution for managing pain and inflammation. Combined with preventative care and professional guidance, these injections can help patients resume their daily activities with improved comfort and mobility.

Contact Alton Pain Clinic today to explore your treatment options and regain control of your life.

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