Lady_stretching_shoulder_landscape_1024-unsmushed_edited_edited_edited.jpg

De Quervain’s disease

What is it? 

The extensor tendons to the thumb run through a tunnel system at the level of the wrist. Thickening of the tendon or narrowing of the tunnel may interfere with tendon gliding, resulting in pain, loss of movement, clicking or grinding.

What is it? 

WhatIsIt.png

How is it diagnosed? 

De Quervain’s disease is diagnosed on the basis of the history described above, and by clinical examination. There may be pain on applying pressure over the affected tendons or on passively flexing the tendons (Finkelstein’s test). An ultrasound scan usually confirms the diagnosis.

Diagnosis.png

What is my approach to treatment? 

70% of patients are cured with a single steroid injection. If this fails then surgery offers a definitive solution in over 95% of cases.

Treatment.png

What does an operation involve? 

Surgery is normally carried out as a day case under general anaesthetic. A tourniquet is applied to the upper arm, similar to a blood pressure cuff. This is so the surgeon can have a clear view of the operative field. Branches of the superficial radial nerve normally lie over the tendon sheath. These need to be mobilised carefully, which is why the procedure is not carried out under local anaesthetic. The fibrous roof of the various tendon tunnels are simply divided and the skin closed with non-absorbable sutures. A long acting local anaesthetic is then administered to provide pain relief. Finally, a dressing and bandaging are applied.

Surgery.png

What is the recovery period? 

Once the local anaesthetic has worn off, normally 6 to 8 hours, simple analgesics and anti-inflammatory tablets may be used for pain. The hand should be kept elevated as much as possible during the first week after the operation, although finger and thumb movements are to be encouraged. A high arm sling may be useful for this purpose. Bandaging is reduced after 5 to 7 days. Sutures are removed in the clinic after two weeks. It should then be possible to wet the hand. Prior to this it’s possible to shower by keeping the extremity dry with a plastic bag secured over the limb using an elastic band or a purpose made shower cover. Most pain and swelling will have settled within four weeks after surgery. Driving is usually possible after 2-3 weeks. When a patient is ready to return to work depends on their specific job role and may also vary from individual to individual. It may be possible to return to light keyboard work towards the end of the first week. Heavy manual work should be avoided for a minimum of 4 weeks.

recovery.png

Are there any possible complications? 

Over 95% of patients are satisfied with the end result. However, as with any treatment, there are always risks involved:Infection: 2%, Chronic regional pain syndrome: 2%, Recurrence: 1% Nerve bruising leading to numbness may occur but normally recovers. Permanent nerve damage is rare.

Complications.png

Click to download the Patient Information Sheet