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De Quervain tenosynovitis — SCE Rheumatology MCQ

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EasyOsteoarthritis and soft tissue rheumatologyDe Quervain tenosynovitisSCE Rheumatology

A 74-year-old woman has radial wrist pain after repetitive lifting. Examination shows tenderness is maximal over the first dorsal compartment. Investigations show Finkelstein test is positive. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: B — Corticosteroid injection

Corticosteroid injection is the best answer because corticosteroid injection is the most appropriate next step for de quervain tenosynovitis in this clinical setting. Therapeutic exercise and weight loss support is a plausible distractor, but it does not account for the key discriminator in the stem. Urgent antibiotics and Surgical opinion would be more appropriate in a different clinical pattern or at another point in the pathway, while Increase NSAID therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE NG226; NICE CKS musculoskeletal topics