Hand & Wrist Conditions
DE QUERVAIN's DISEASE
What is De Quervain's Disease?
De Quervain's disease or De Quervain's tenosynovitis is a painful condition affecting the radial (thumb) side of the wrist. There is an inflammation of two of the thumb tendons where they pass through a tunnel at the wrist.
Why does it occur?
No one knows for certain but it may be related to injury or repeated activities. New mothers seem to get the condition more commonly than others. This may be due to hormonal changes or due to repeatedly lifting the baby. There is no conclusive evidence that it is caused by "repetitive strain" at work, but the condition can be aggravated by manual activities eg gardening, racquet sports etc.
Is it harmful?
No. It is a harmless and often self-limiting condition. Some mild cases will resolve spontaneously over a period of a few weeks. In other patients, it can persist as an aching pain made worse by use if the hand.
What are the symptoms?
Pain and swelling of the wrist on the thumb side. It is tender to touch here and along the tendons extending into the thumb. Sometimes the tendons can click or snap.
How is it diagnosed?
Usually it is easy to diagnose from the history and the clinical examination. Typically, placing the thumb into the palm and closing the fingers over it, followed by bending the wrist towards the little finger side reproduces and aggravates the pain (Finkelstein's test).
How is De Quervain's disease treated?
Initial treatment is non-operative. This usually involves rest, avoidance of activities that aggravate the pain, use of a wrist or thumb splint and anti- inflammatory tablets or ointments.
If these simple measures do not succeed in relieving the symptoms, then a steroid injection can be administered. This has a success rate of about 70-80%. An occasional side effect is skin thinning or depigmentation at the injection site.
What about surgery?
If the above measures are unsuccessful, then surgery is indicated. Surgery involves admission as a day case and usually involves having a general anaesthetic ( ie the patient is asleep), though surgery can also be performed under local or regional anaesthetic . During the operation, an transverse or longitudinal incision will be made that is about 2-3 cm long. The roof of the tendon tunnel is divided, thus freeing up the tendons. It is usually closed with absorbable stitches which do not require removal. A bulky bandage is applied which is removed about 48-72 hours later. There will be a small adhesive dressing beneath the bulky dressing, and this is left in place for about 10 days. Sometimes a sling is worn for a day or two to keep the arm safe from accidental knocks. Hand and finger movements are encouraged. The thumb should be rested as much as possible in a splint for the first two weeks and the wound kept dry. Thereafter, gradually increasing activities are allowed.
What about return to work?
In case of office jobs, most patients return to work within a few days. For heavy manual jobs, a period of a few weeks off may be required.
What are the possible complications of surgery?
Surgery for De Quervain's disease is a minor procedure and complications tend to infrequent. Infection occurs in about 1% and usually responds very well to antibiotics. The scar may sometimes be tender, hypersensitive and thick. Clots in the arm or elsewhere are very rare- under 0.1%. The skin near the scar may be numb after the operation, but this usually improves with time. Rarely unexpected swelling, stiffness and pain can occur. This is called RSD ( Reflex Sympathetic Dystrophy) and may require extended physiotherapy or other treatments. Very rarely, permanent stiffness can occur. Other possible but infrequent complications include damage to local nerves and partial dislocation of the released tendons. Very rarely, a general anaesthetic can cause complications. Pre- surgery tests will minimise this risk.
How successful is surgery?
The success rate is over 90%.