# De Quervain tenosynovitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Kenalog Intra-articular / Intramuscular Injection (triamcinolone acetonide 40 mg/ml) SmPC sections 4.1 and 4.2 (eMC product 6748), which carries tenosynovitis as a labelled indication: "For intra-articular administration or injection into tendon sheaths and bursae, the dose of Kenalog Injection may vary from 5 mg to 10 mg (0.125 - 0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints, depending on the specific disease entity being treated." The label's band for a small structure stops at 10 mg while the range given here reaches 20 mg, under the label's 40 mg single-site ceiling. · AAOS Clinical Practice Guidelines · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - Verified date: 2026-08 ## Verified against - Kenalog Intra-articular / Intramuscular Injection (triamcinolone acetonide 40 mg/ml) SmPC sections 4.1 and 4.2 (eMC product 6748), which carries tenosynovitis as a labelled indication: "For intra-articular administration or injection into tendon sheaths and bursae, the dose of Kenalog Injection may vary from 5 mg to 10 mg (0.125 - 0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints, depending on the specific disease entity being treated." The label's band for a small structure stops at 10 mg while the range given here reaches 20 mg, under the label's 40 mg single-site ceiling. - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - AAOS Clinical Practice Guidelines ## Treatment metadata - Naproxen — 500 mg — oral.solid - Triamcinolone acetonide — 40 mg — injection ## Complete treatment card ```text DE QUERVAIN TENOSYNOVITIS Sources: Kenalog Intra-articular / Intramuscular Injection (triamcinolone acetonide 40 mg/ml) SmPC sections 4.1 and 4.2 (eMC product 6748), which carries tenosynovitis as a labelled indication: "For intra-articular administration or injection into tendon sheaths and bursae, the dose of Kenalog Injection may vary from 5 mg to 10 mg (0.125 - 0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints, depending on the specific disease entity being treated." The label's band for a small structure stops at 10 mg while the range given here reaches 20 mg, under the label's 40 mg single-site ceiling. · AAOS Clinical Practice Guidelines · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Radial-sided wrist pain that worsens with thumb and wrist movement [joint pain · wrist pain] - Pain or difficulty when opening a jar lid - Think of this in someone nearing the end of pregnancy or a nursing mother who often carries her baby SIGNS - what you find (5) - Tenderness directly over the radial styloid - Any swelling is usually seen proximal to the radial styloid - Finkelstein test: thumb held in palmar flexion while the wrist is passively deviated toward the ulna reproduces sharp radial wrist pain if positive [joint pain · wrist pain] - Eichhoff test: clenching the thumb inside a fist while deviating the wrist ulnarward elicits a sharp radial pain if positive - WHAT test: combined wrist hyperflexion with thumb abduction is another provocative maneuver used TESTS (3) - The diagnosis is made clinically from the history and exam, not from imaging - X-rays are not diagnostic on their own but can screen out other causes of pain at the radial wrist, like thumb-base arthritis - Ultrasound can locate a septum within the first dorsal compartment, which raises the success rate of steroid injection IF NOT THIS - what else fits (6) - Osteoarthritis of the thumb carpometacarpal joint is part of the differential - A scaphoid fracture should also be considered - A radial styloid fracture is part of the differential - Wartenberg syndrome, a sensory radial nerve neuritis, can present similarly - Intersection syndrome is part of the differential - Trigger thumb is part of the differential Source StatPearls "De Quervain Tenosynovitis" - disease-level clinical article Status traced to the source above 1. NAPROXEN [1st line] Adult 500 mg twice daily with food combined with thumb spica splinting x 2-4 weeks Peds Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead. Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why Non-selective NSAID combined with thumb spica splinting for De Quervain tenosynovitis; it reduces the inflammatory pain of the tendon sheath while the splint rests the affected tendons. Caution Thumb spica splinting of first dorsal compartment is an essential non-pharmacological co-therapy. Take with food or co-prescribe PPI in patients at risk for peptic ulceration. Contraindicated in active GI bleed, severe heart failure, or CKD. Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) 2. TRIAMCINOLONE ACETONIDE [2nd line] Adult 10-20 mg injected into first dorsal extensor compartment sheath (procedural injection) - single dose Peds Specialist orthopedic referral required Source Kenalog Intra-articular / Intramuscular Injection (triamcinolone acetonide 40 mg/ml) SmPC sections 4.1 and 4.2 (eMC product 6748), which carries tenosynovitis as a labelled indication: "For intra-articular administration or injection into tendon sheaths and bursae, the dose of Kenalog Injection may vary from 5 mg to 10 mg (0.125 - 0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints, depending on the specific disease entity being treated." The label's band for a small structure stops at 10 mg while the range given here reaches 20 mg, under the label's 40 mg single-site ceiling. Why High cure rate (>80%) for corticosteroid sheath injection when splinting and oral NSAIDs fail Caution Avoid intratendinous injection (risk of tendon rupture). Subcutaneous atrophy and skin depigmentation at injection site can occur. A transient post-injection pain flare can occur for 24-48 hours. Egypt PHARCOCINOLONE 40MG/ML I.M AMP. CHEMIPHARM > ... 8.00 EGP AMCINOL 40MG/ML I.M AMP. SIGMA TEC 11.00 EGP EPIRELEFAN 40MG/ML I.M AMP. EIPICO 38.00 EGP SYNTHECORTIN 40MG/ML I.M AMP. MUP 54.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)