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De Quervain's Tenosynovitis

De Quervain's Tenosynovitis

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  • 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

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  • 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 pre disposition, such as unusually shaped tendons.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • The operation is done by a small incision on the side of the wrist.

  • The sheath around the tendon is released so that the tendon can glide freely

  • The wound is sutured and a dressing is applied.

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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

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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.

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  • 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 (usualy 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  ate 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)

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  • 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

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

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