Author: I Chakrabarti with additional material by A. Kocheta
WHAT IS DE QUERVAIN’S SYNDROME?
De Quervain’s Syndrome goes by a variety of names: “De Quervain’s Tenosynovitis,” “De Quervain’s Tenovaginitis,” “De Quervain’s Tendinosis” and “De Quervain’s Tendinitis” being the commonest ones. They all describe the same condition.
The tendons (sometimes referred to as “guiders”) of the thumb run through a tunnel (see figure 1) and the roof of that tunnel becomes thickened. A painful, hard lump appears (see figure 2).
People with this condition have pain in the wrist, close to the area around the base of the thumb, which often spreads up the arm and down into the hand. Moving the thumb makes it worse.
What Causes De Quervain’s Syndrome and who gets it?
We don’t know what causes it. However, it is more common in nursing mothers, women in the last three months of pregnancy and women going through the menopause. Hormones may be partly responsible. Frequently there is an inborn (congenital) variance in anatomy that is associated with the syndrome. This does not affect hand or wrist function but can make it more likely to have DeQuervain’s pain.
Men can also suffer from this condition, but rarely.
It is NOT an inflammation of the tendons.
Treatment for De Quervain’s Syndrome
There are several treatments available:
Wearing a splint can help. However, it needs to be one that includes the thumb. There are many such splints available to buy and, if in doubt, it is best to consult your doctor or a Hand Therapist.
Steroid injection around the painful area is highly effective. Some Hand Therapists are trained in this technique as are many General Practitioners. In combination with a suitable splint, this cures the condition in most cases. Complications are rare though some people experience thinning of the skin at the injection site with some discolouration – usually loss of pigmentation resulting in a pale area.
Surgery. If splints and an injection don’t work, an operation to remove the roof of the tunnel and release the tendons can be performed (see figure 3). This usually done under a Local Anaesthetic (an injection around the painful lump to numb the skin and tissues underneath) using a small incision which may be straight, curved or s-shaped.
After the Operation
You will have a bandage or a splint (which may be plaster-of-Paris) depending on the surgeon’s recommendation. It is important to keep the hand elevated and move your fingers as much as possible to avoid swelling and stiffness. Regular painkillers, such as Paracetamol and Ibuprofen, are recommended.
After 10-14 days, you may need to have some stitches removed either at the GP practice or at the hospital. The scar will be tender and sensitive once it has healed – it is important to massage it as much as possible and a non-perfumed skin moisturiser (such as E45) can be applied. Massage the scar firmly and for one inch (25mm) all around it. Do this for 1-2 minutes 3-4 times a day. This may be uncomfortable to start with but persevere as this will reduce the swelling and tenderness faster than leaving it alone.
Risks of Surgery
Infection. This is rare: less than one in a hundred cases. However, if it should occur, it is usually treated successfully with antibiotics.
Nerve damage. This also uncommon. Small nerves around the operation site can be stretched and bruised; if so, you may have a numb patch in that area and back of the thumb. This usually settles by itself but may take a few weeks. It is unlikely to be permanent.
Scar tenderness/sensitivity. The scar is often tender and sensitive at first. However, it usually settles with skin massage.
Stiffness. There may be some stiffness of the thumb and wrist to start with, but this nearly always settles.
Do not forget that you will not be able to use the hand that has been operated on fully for a short while after surgery. Make life easy for yourself at home by planning ahead, particularly if you are alone at home or if you will be alone at home for long periods in the day. Get enough shopping in to last for a week or two after your surgery, as you will not be able to drive. Loosen the tight caps of jars (but don’t forget the contents will go off more quickly). Ready-meals might be useful for a few days after surgery or do some cooking before and freeze it. Wear slip-on shoes so you don’t have to tie laces etc.