General Guideline Principles for Extensor Compartment

Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis

and Intersection Syndrome) for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome) of Hand, Wrist and Forearm Injuries

When jobs require repeated forceful gripping or sustained wrist extension, De Quervain’s stenosing tenosynovitis may occur. However, the majority of cases are unlikely to be occupational. The most common extensor compartment tendinose is De Quervain’s.

  1. Diagnostic Studies of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

    Diagnostic Studies of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome) X-Rays is not recommended are usually ineffective and thus not recommended.

    The cutoff for testing for confounding conditions like diabetes and hypothyroidism should be low. Extensor Compartment Tenosynovitis: Evidence for the Use of Special Studies

     

  2. MRI

    MRI is not recommended to determine the presence of extensor compartment tenosynovitis.

    MRI are recommended when there is an ambiguous diagnosis and/or a failure to respond appropriately to clinical treatments, particularly injection.

Medications of Hand, Wrist and Forearm Injuries

For most patients, ibuprofen, naproxen, or other older generation NSAIDs are recommended as first-line medications.
Acetaminophen (or the analog paracetamol) may be a reasonable alternative to NSAIDs for patients who are not candidates for NSAIDs, although most evidence suggests acetaminophen is modestly less effective. There is evidence that NSAIDs are as effective for relief of pain as opioids (including tramadol) and less impairing.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Extensor Compartment Tenosynovitis

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Extensor Compartment Tenosynovitis are recommended extensor compartment tenosynovitis, whether acute, subacute, or chronic

    Indications – NSAIDs are prescribed for acute, subacute, and chronic pain. Over-the-counter (OTC) medications may be adequate and should be tried first.

    Frequency/Duration: For many patients, using it as needed may be appropriate. Discontinuation is indicated when symptoms have resolved, there is a lack of efficacy, or adverse effects have developed, necessitating discontinuation.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors should be used concurrently in patients at high risk of gastrointestinal bleeding.

    Indications:Cytoprotective medications should be considered for patients with a high-risk factor profile who also have indications for NSAIDs, especially if long-term treatment is planned. Patients at risk include those who have a history of gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers.

    Frequency/Dose/Duration: Proton pump inhibitors, misoprostol, sucralfate, and H2 blockers are recommended. Dose and frequency should be determined by the manufacturer. There are no significant differences in efficacy for gastrointestinal bleeding prevention.

    Indications for Discontinuation: Intolerance, adverse effects, or discontinuation of an NSAID.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    The risks and benefits of NSAID therapy for pain should be discussed with patients who have known cardiovascular disease or multiple risk factors for cardiovascular disease.

     

  4. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as first-line therapy appears to be the least risky in terms of cardiovascular side effects.

       

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred over COX-2 specific drugs.

      To reduce the possibility of the NSAID counteracting the beneficial effects of aspirin in patients receiving low-dose aspirin for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or 8 hours before the daily aspirin.

       

  5. Acetaminophen for Treatment of Wrist compartment Tendinitis Pain

    Acetaminophen for Treatment of Wrist compartment Tendinitis Pain is recommended for the treatment of wrist compartment tendinitis pain, especially in patients who are contraindicated to NSAIDs.

    Indications: All patients suffering from wrist compartment tendinitis pain, whether acute, subacute, chronic, or post-operative.

    Dose/Frequency: According to the manufacturer’s recommendations; may be used as needed. When taken in excess of four grammes per day, there is evidence of hepatic toxicity.

    Indications for Discontinuation: Pain relief, adverse effects, or intolerance

     

  6. Opioids of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

    Opioids of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome) is not recommended for acute, subacute, or chronic extensor compartment tenosynovitis

    Opioids of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome) is recommended for brief (no longer than seven days) usage as an adjuvant therapy to more potent therapies for postoperative pain control.

    Indications: It is frequently necessary, especially at night, to provide short-term opioids as adjuncts to more effective treatments (notably NSAIDs, acetaminophen).

    Frequency/Duration: Prescribed as needed throughout the day, then later only at night, before weaning off completely.

    Rationale for Recommendation: A careful use of opioids, especially for nighttime use, may be beneficial for patients for whom NSAIDs do not provide adequate pain relief. It is advised that postoperative patients only use opioids sparingly and selectively, primarily at night to induce sleep.

Treatment of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Initial care usually involves limitation of the physical factors thought to be contributing. Thumb spica splints for de Quervain’s and wrist braces for the other compartment tendinitis are generally believed to be helpful.

Thumb spica splints have been widely used for treatment of wrist compartment tendinoses while nonspica wrist splints have been used for treatment of other compartment tendinoses. NSAIDs are often prescribed for initial treatment.

Mobilization / Immobilization of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Thumb Spica and Wrist Splints for Acute and Subacute Thumb Extensor Compartment Tenosynovitis

Thumb Spica and Wrist Splints for Acute and Subacute Thumb Extensor Compartment Tenosynovitis are recommended for the treatment of various extensor compartment tendinoses as well as non-spica wrist splints for the treatment of acute and subacute thumb extensor compartment tendinoses.

Frequency/Duration – It is typically advised to wear them while awake. warning signs of

Discontinuation – Resolution or non-response.

Rehabilitation of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active interventions should be prioritised.

To maintain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy: Active of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

  1. Therapeutic Exercise – Acutely

    Therapeutic Exercise – Acutely is not recommended because an exercise regimen is typically not necessary for patients with extensor tendon entrapment.

     

  2. Therapeutic Exercise – Residual Defects

    Therapeutic Exercise – Residual Defects is recommended especially after surgery.

    Frequency/Dose/Duration – With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

    If there is evidence of functional improvement toward specific objective functional goals, more than 12 to 15 visits may be necessary when there are persistent functional deficits (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities).

    A home exercise programme should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Therapy: Passive of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Iontophoresis for Acute and Subacute Extensor Compartment Tenosynovitis

Iontophoresis for Acute and Subacute Extensor Compartment Tenosynovitis are recommended glucocorticoids and occasionally NSAIDs are used for specific patients with wrist compartment tendinoses. who either refuse injection or do not respond well to NSAIDs, splints, and activity modifications.

Frequency/Duration – Usually two or three treatments are necessary to determine effectiveness; if effective, another four to six treatments may be planned. Additional four to six treatments are reasonable if improvements persist after six sessions.

Indications for Discontinuation – Failure to act, the emergence of negative effects, and resolution.

Other Passive Interventions of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Other Passive Interventions

Other Passive Interventions is not recommended Other Non-operative Interventions for Acute, Subacute, or Chronic Extensor Compartment Include Manipulation and Mobilization, Massage, Deep Friction Massage, or Acupuncture Tenosynovitis

Extensor Compartment Tenosynovitis: Acupuncture’s Benefits as a Treatment

Injection Therapy of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Injection Therapy Glucocorticosteroid Injections
Injection Therapy Glucocorticosteroid Injections is recommended to treat wrist compartment tendinosis that is acute, de Quervain’s, or another type.

Indications – symptoms of pain over a compartment on the wrist. Usually, it takes at least a week of non-invasive treatment to see if the condition will go away on its own. It makes sense to start treating cases with an injection.

Frequency/Duration – It is advised to schedule a single injection and assess the outcomes to document improvement.

The diagnosis should be reevaluated and a second injection should be taken into consideration if there is no response or a subpar response within two to three weeks. The need for a surgical evaluation may be indicated by the return of symptoms.

Surgery of Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

Surgery – Surgical Release

Surgery – Surgical Release is recommended for patients who do not respond to injection and have subacute or chronic extensor compartment tenosynovitis.

Indications – wrist compartment tenosynovitis that is unresponsive to nonoperative treatments, which typically include two injections of glucocorticoids.

What our office can do if you have Extensor Compartment Tenosynovitis (Including de Quervain’s Stenosing Tenosynovitis and Intersection Syndrome)

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

5.0
Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
js_loader

Disclaimer

Complete Orthopedics is a medical office and we are physicians . We are not attorneys. The information on this website is for general informational purposes only.

Nothing on this site should be taken as legal advice for any individual case or situation. The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions.

You should not rely on any of the information contained on this website. You should seek the advice of a lawyer or physician immediately for more accurate information surrounding any legal or medical issues.

This information has been posted for informational and/or advertisement purposes only. You consent to these terms and conditions by using our website

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.