3) Treatment Options - Rest of the thumb and wrist with or without splinting to reduce the possible aggravating friction on the tendons tends to afford a slow recovery. Applying ice at the radial styloid (the bony eminence on the thumb side of the wrist where the tendons pass) may also decrease inflammation and symptoms. Initial more aggressive therapy involves injection of the first dorsal compartment (the area which houses the involved tendons) with a mixture of an anti-inflammatory drug (steroid) and local anesthetic. It may also be helpful to place the affected wrist in a removable splint to immobilize the thumb and prevent further irritation and inflammation. A recent study concluded that injecting this compartment can provide complete relief of symptoms. If symptoms improve, adding gentle stretching exercises (stretch the thumb into the palm) can prevent recurrent inflammation. If the symptoms persist after injection, then the injection can be repeated (30% of cases require reinjection after one year). If 2-3 injections over a 3-5 week period fail to give relief, then surgical management becomes appropriate.
Surgical management involves incising the skin, identifying and cutting the diseased tendon sheath under local anesthesia, and applying a compression bandage. Patients can usually return to their normal activities within 2-3 weeks after surgery. This procedure is successful 90% of the time.
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