Dawaa Reference

Clinical reference

De Quervain tenosynovitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against3 documents
  • 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

Verified date2026-08

Presentation reference

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

SourceStatPearls "De Quervain Tenosynovitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NAPROXEN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily with food combined with thumb spica splinting x 2-4 weeks

Paediatric dose

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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ORGOPROXEN 500 MG 20 TAB.ORGANOPHARMA > ORGANO16.00 EGP (0.80/unit)
NAPROSYN 500 MG 10 TAB.MISR > F.HOFFMAN LA ROCHE8.05 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

Strength40 mg

Forminjection

Adult dose and duration

10-20 mg injected into first dorsal extensor compartment sheath (procedural injection) - single dose

Paediatric dose

Specialist orthopedic referral required

Dose 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

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
PHARCOCINOLONE 40MG/ML I.M AMP.CHEMIPHARM > PHARCO B8.00 EGP
AMCINOL 40MG/ML I.M AMP.SIGMA TEC11.00 EGP
EPIRELEFAN 40MG/ML I.M AMP.EIPICO38.00 EGP
SYNTHECORTIN 40MG/ML I.M AMP.MUP54.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.