De Quervains Syndrome
De Quervain’s syndrome is a common condition affecting the tendons on the thumb side of the wrist.
What are the symptoms?
Pain is felt on the thumb side of the wrist. This is worse with movement and use of the thumb, or when gripping objects. The hand and wrist feel weak.
There may be localised swelling or a sensation of grating or popping. Sometimes, there is some associated numbness in the same region.
What is the cause?
As the tendons from the forearm to the thumb passes the wrist, then go through various tunnels in a strap of tissue called the extensor retinaculum. This structure keeps the tendon bound down in its correct position against the wrist. The tendon is lubricated by a thin layer of tissue called tenosynovium. De Quervain’s syndrome occurs when the tendon undergoes localised degeneration in this area, or the tenosynovium becomes irritated and inflamed.
Generally, De Quervain’s syndrome is an overuse condition. That is, highly repetitive use of this tendon due to gripping, lifting or twisting may cause this syndrome. It is very common in mothers with young babies.
It may also be associated with an underlying fracture of the radius, or with more generalised medical conditions such as diabetes and inflammatory arthritis (eg. rheumatoid arthritis).
How is De Quervain's syndrome diagnosed?
De Quervain’s syndrome is diagnosed from the patient’s history and the examination. Generally, further tests are not required for a diagnosis, although an X-ray is helpful to look for any underlying bony abnormalities that might be irritating the tendon.
How is De Quervain's syndrome treated?
The crux of non-surgical treatment is to break the cycle of inflammation and pain. Various options include: ·
- Avoid aggravating activities. This is the most important part of the treatment, but is often impossible to fully achieve. Try to adapt the home or workplace activities, or to take frequent breaks.
- A thumb spica splint fitted by a therapist can help rest the tendon by supporting the thumb.
- An exercise program from a therapist to maintain movement and strength.
- Anti-inflammatory tablets or creams.
- A cortisone injection is very good at settling inflammation and swelling, and thus relieving pain. This may need repeating once to fully resolve the symptoms.
Surgery is recommended in very severe disease or if other treatment fails.
Surgery is performed via a small incision over the affected area, in order to release the tight retinaculum over the tendon.
Surgery is done as a day-only procedure in a hospital. It can be performed under local anaesthetic with the patient awake, or under general anaesthesia with the patient asleep.
What to expect after the operation?
A bulky dressing will be applied to the surgical site in the operating room at the end of the operation. This should be kept dry and elevated until your follow-up appointment in about 10 days.
Full range of motion and use of the hand and wrist are permitted once the wound has healed, although this will be initially limited by the post-surgical pain. A hand therapist can assist with regaining motion and strength.
About 90% of patients will have full resolution of symptoms after an operation, but it may take 6-12 months for all symptoms to disappear. Tenderness at the incision can also persist for several months.
What are the risks of surgery?
Complications from surgery are uncommon. The usual risks are:
- Nerve, tendon or blood vessel damage
- Post-operative pain often persists for several months, but gradually decreases
- Persistent De Quervain’s pain may occur in up to 10% of patients
- Complex regional pain syndrome.