De Quervain's Tenosynovitis

What is De Quervain’s tenosynovitis?

Thumb movements are powered by muscles in the forearm. The Muscles are connected to the fingers by tendons.
To stop the tendons from ‘bow stringing’ with wrist and finger movement, there is a tunnel formed by bone and ligaments at the wrist.
If there is swelling around a tendon, the tendon becomes thicker, or the tunnel narrower – the tendon cannot glide freely through its tunnel.
The area becomes inflamed and painful, especially with thumb movement

What is De Quervains?

What are the causes?

The most common cause is over use, that causes inflammation. Excessive use of scissors is an example.
Some people are prone to swelling and inflammation (synovitis) around their tendons. For example those with rheumatoid arthritis.
An injury such as a wrist fracture or a direct blow to the side of the wrist.
There can be a structural predisposition, such as unusually shaped tendons.

If usually starts with tenderness on the wrist at the base of the thumb, that is aggravated by movement of the thumb.
In severe cases there can be crepitus (clicking and grinding) on thumb and wrist movement.

How does it present?

Avoid activities that cause pain in the finger. (Gripping, pinching, using scissors etc.)
Wearing a splint that stops the thumb from moving (it is usually fitted by a hand therapist).
Consider taking an anti inflammatory.
A steroid injection around the tendon can resolve the issue, or at least give relief for a while.

Avoid activities that cause pain in the finger. (Gripping, pinching, using scissors etc.)
Wearing a splint that stops the thumb from moving (it is usually fitted by a hand therapist).
Consider taking an anti inflammatory.
A steroid injection around the tendon can resolve the issue, or at least give relief for a while.

What can be done?

When non operative treatments (mentioned in the previous slide) is unsuccessful.
Surgery is usually the best option if De Quervains Tenosynovitis has been present for a long time
If you would prefer a definitive cure for the problem.

When is surgery needed?

This kind of surgery is usually done under local anaesthetic with or without sedation (‘twilight anaesthetic’)
It is done as day case surgery in a hospital,
- but you cannot drive after the procedure and
- you should not be home alone on the night of the surgery.
Antibiotics are usually not necessary at the time of surgery.

How does surgery work?

What do we do in surgery?

In Hospital

There will be a bandage on the wrist.
It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
Usually the area is still numb from local anaesthetic.
It is usual to leave hospital an hour or two after surgery

At Home

It is usual for the hand to feel numb for about one day after surgery, due to the local anaesthetic.
Continue to elevate your arm until swelling in your wrist and fingers subside.
Please keep the bandage on the wrist in place until your first review at my rooms.
Move your thumb (touching the little finger and straightening it out fully about 10-20 times a day).
An appointment usually arranged at my practice nurse at about 1-2 weeks after surgery.

After the surgery

The wound usually heals over 1-2 weeks and any sutures are then removed
Self care (washing, dressing, eating) with the operated hand – usually around 5 days
Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)
Most moderate activities (equivalent to lifting a pot of the stove or pouring a full kettle) can usually be tolerated by 4-6 weeks,
Scarring at the site of the surgery, where the tendon sheath was divided can be slightly thick and tender for months (3-6).
Golf, fishing, cycling etc.: usually around 2-3 months, but it can be longer (6 months)

The recovery

Occasionally there can be damage to a skin nerve, resulting in tingling, numbness and sensitivity at the scar and on the back of the hand.
Infection occurs rarely (1% of the time). It is rarely severe.
There may be ongoing pain from scarring, or other worn out joints in the area such as the joints at the base of the thumb
Sometimes the scar can be very sensitive and thick, limiting thumb and wrist movement.
Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.
Rarely, the released tendons can become unstable and slip backwards and forwards over the side of the wrist as it moves.
A second tendon running in its own tunnel can be missed during surgery and can cause ongoing problems

A full recovery is usually expected from a De Quervains release.