De Quervain's Tenosynovitis
Dual Syringe Injector Manual (PDF)
Thickening of the thumb´s extensor tendons in the first extensor compartment at the wrist combined with narrowing of the compartment is called morbus de Quervain. The symptoms are pain at the radial side of the wrist, especially when loading and extending the thumb. Injecting steroid into the first compartment will eliminate oedema and inflammation and relieve pain. It is most important not to inject the steroid into the tendon itself, which might produce a tendon rupture. Atrophy of the skin and subcutaneous tissue is common and should be avoided. Injury of the superficial radial nerve branches may occur with improper injection technique.
Note! The radial nerve branches have a superficial position and might be injured by the steroid. If paresthesias occur, change the needle position before injecting steroids!
Technique: Clean the injection site with alcohol. Use gloves when injecting steroids. The first dorsal extensor tendon compartment is reached at the styloid process of the radius at the base of the thumb. Introduce the needle through the skin distally, aiming at an oblique angle into the tendon sheath. Inject local anesthesia with the Dual Injector while penetrating the skin, advance the needle deep into the tendon and check that the needle moves with the tendon when moving the thumb. Retract the needle until it no longer moves with the tendon. With this technique, a correct placement of the needle tip is guaranteed inside the compartment but outside the tendon. Inject 0,25 cc of Lederspan®. Inject anesthesia when retracting the needle to prevent steroid deposition subcutaneously. Put adhesive tape over the needle spot. Use a thumb splint to immobilize the thumb and wrist for 2 - 3 days.
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