De Quervains Tenosynovitis

De Quervain’s is a narrowing of two tendons that control movement of the thumb due to repetitive thumb movement which causes friction, irritation and swelling. In certain patients one of the tendons run in a sub-sheath and these patients are predisposed to De Quervain’s.

While afflicting a wide range of people, it is more common in women older than 50, or those who have recently given birth. Interestingly the condition is now sometimes reported in teenagers due to repetitive thumb movements when using smart phones.

Clinically the pain is felt at a precise point on the thumb side of the wrist and may be very painful and disabling.

Any movement pulling the thumb and/or wrist to the little finger side may be exquisitely painful. The diagnosis is clinical and usually there is no need for special investigations.

  • Management

Patients respond well to conservative management with avoidance of precipitating movements (often a splint is helpful in this, but splints have not been shown to alter the course of the disease), oral analgesics and anti-inflammatories. If a steroid injection is required, 8 in 10 patients respond well. It is worth noting though that repeat injections in the region discolour the skin permanently and cause tissue degeneration.

Surgical release involves a small incision over the wrist, completely releasing the narrowed pulley through which the tendons pass. This may be done under local or general anaesthetic, depending on the patient’s needs.

Many patients feel better within a week or two following surgery, but full rehabilitation may take 6 weeks to 3 months. The wrist is splinted for a week post surgery and the key to recovery is to keep the thumb tendons gently gliding in the newly released tunnel.

Therapy will include scar and swelling management, wrist and thumb range of movement and strengthening with and occupational hand therapist

Conditions Managed

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