What initial conservative management strategies should be implemented for a patient diagnosed with De Quervain's tenosynovitis?

For a patient diagnosed with De Quervain's tenosynovitis, the initial conservative management strategies aim to provide pain relief and restore physical function ¹. These strategies typically include:

• Activity Modification and Rest: Advise the patient to rest the affected arm and avoid or reduce activities that aggravate symptoms, particularly those involving high force, hand-gripping, or pinching ¹. This modification should be maintained for approximately 6 weeks, while encouraging the patient to continue other activities where possible ¹.
• Thermal Therapy: Applying heat or ice to the affected area can help relieve pain ¹.
• Orthoses/Splinting: Consider the use of an orthosis, such as a wrist brace or splint, as it may provide symptom relief by offloading and decreasing stress on the affected tendons ¹,². Immobilization with a brace, splint, or orthosis has strong evidence to improve patient-reported outcomes in similar conditions ².
• Analgesia: Offer paracetamol or a topical nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen gel, as first-line options for symptom relief ¹. If using topical ibuprofen gel, advise the patient to avoid smoking and other naked flames due to the risk of severe burns, as fabrics in contact with the gel burn more easily ¹. If symptoms persist, consider prescribing an oral NSAID ¹.
• Patient Information and Advice: Provide appropriate information and advice regarding their condition and management plan ¹.

If there is no response to these initial treatments after 6 weeks, reassessment and consideration of alternative diagnoses or referral to physiotherapy for interventions like stretching and strengthening exercises may be necessary ¹. It is important not to routinely offer corticosteroid injections, as they may provide short-term relief but are unlikely to affect long-term outcomes, and relapses are common ¹.