Splinting vs Exercise in De Quervain's Tenosynovitis

Patients who meet the inclusion and exclusion criteria will undergo a detailed clinical examination and medical history review, after which written informed consent will be obtained. They will then be randomly assigned to one of the two treatment groups using block randomization.

Baseline sociodemographic data (age, sex, body mass index, employment status, education level, marital status) and clinical variables (dominant hand, symptom duration, comorbidities, affected hand, presence of the Finkelstein sign, pain severity, functional/symptom status, hand-finger strength, pressure pain threshold (PPT), and ultrasonographic findings) will be recorded.

Patients in the first group will be provided with a static wrist-hand resting splint with thumb support, extending to the distal forearm. They will be instructed to wear the splint for at least 6-8 hours per day for a minimum of 4 weeks. Additionally, both groups will receive training on activity modification and positioning.

Patients in the second group will be given a home exercise program. They will perform the exercises twice daily for 6 weeks, with each exercise consisting of 10 repetitions. All patients will be evaluated at baseline, at the second week of treatment, and at the end of the sixth week.

Outcome measures will include clinical examination findings (Finkelstein test), pain severity \[Visual Analog Scale (VAS) at rest and during activity\], the Turkish versions of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, Health Assessment Questionnaire (HAQ), and Patient-Rated Wrist Evaluation (PRWE), patient satisfaction, handgrip and finger pinch strength measurements, and pain pressure threshold using an algometer.

Ultrasound evaluations of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment including the measurement of the cross-sectional area (csa) will be performed at baseline, week 2, and week 6.

All assessments will be conducted by the same blinded investigator who is unaware of the group allocations

Not reported in this registry record.

Other: splint

Not reported in this registry record.

Other: Exercise Therapy

static wrist-hand splint + education on activity modification and positioning in daily life

Home-based Exercise Therapy + Education on activity modification and positioning in daily life

Time frame: baseline, week 2 and week 6

VAS pain activity and rest: 0 no pain; 10 unbearable/max. pain.

Time frame: baseline, week 2 and week 6

The Patient-Rated Wrist Evaluation (PRWE) is a brief and effective self-report questionnaire that allows patients to assess their own wrist and hand problems. The PRWE consists of two main subscales: the Pain Subscale (0-50 points) and the Function Subscale (0-50 points). The total score ranges from 0 (no disability) to 100 (maximum pain and functional impairment).

Time frame: baseline, week 2 and week 6

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a self-reported outcome measure used to assess the impact of upper extremity disorders on daily activities. It consists of 30 items, each scored on a 5-point Likert scale ranging from 1 (no difficulty) to 5 (unable to perform). The total score ranges from 0 to 100, where 0 indicates no disability and 100 indicates severe functional limitation.

Time frame: baseline, week 2 and week 6

Hand Grip Strength (HGS):

Following the definitions outlined in the literature, HGS will be measured using Jamar hand dynamometers. The patients will be asked to squeeze the dynamometer three times with maximum strength, allowing 30-60 seconds of rest between each attempt. The average force (in pounds/kg) will then be recorded.

Time frame: baseline, week 2 and week 6

Finger Pinch Strength (FGS):

Following the definitions outlined in the literature, FGS will be measured using Baseline pinch dynamometers. The patients will be asked to squeeze the dynamometer three times with maximum strength, allowing 30-60 seconds of rest between each attempt. The average force (in pounds/kg) will then be recorded.

Time frame: Baseline, week 2 and week 6

Ultrasonographic evaluation of the Abductor Pollicis Longus (APL) Extensor Pollicis Brevis (EPB) will be performed with a LA2-14A transducer /superficial linear probe(Samsung).The patient is seated with the forearm in a neutral position and the palm resting on a flat surface. The wrist is slightly extended to expose the radial side. A high-frequency linear transducer (typically 10-18 MHz) is placed transversely over the radiocarpal joint at the wrist, just proximal to the radial styloid.

The first dorsal compartment is visualized in cross-sectional (short axis) view. Both tendons (APL and EPB) appear as oval or round hyperechoic structures within the tendon sheath. Peritendinous edema is assessed semiquantitatively (0-3based on its visual appearance around the tendon.CSA (mm2) measurements will be performed using USG with high sensitivity, reflecting tendon thickening or swelling due to inflammation. The mean of three measurements will be calculated for analysis.

Time frame: week 2 and week 6

Patient satisfaction (Subjective impression of improvement):

Satisfaction levels of patients will be questioned. In the assessment consisting of five clauses with Likert-type scales, the clauses will be described as follows: 1, 'no satisfaction at all'; 2, 'no satisfaction'; 3, neutral (no positive or negative effect); 4, 'satisfied'; and 5, 'very satisfied'.

Comparison of Static Hand-Wrist Splinting and Exercise Therapy in the Management of De Quervain's Tenosynovitis