Dequervian's Tenosynovitis

DeQuervain's tenosynovitis is a "wear and tear" issue. In the vast majority of people it is not clear why it has developed .

The presenting problem is always pain on the outside of the wrist a few centimetres back from the base of the thumb. It often is at about the level where your watch band would sit. Often this pain is very distressing.

The pain is made worse by movement of the wrist. Usually the patient can show you very specifically where the painful point is and it is extremely tender to touch.

The pain is caused by inflammation (swelling and irritation) within a tunnel which encloses tendons which are running to the thumb.

Treatments:

We have both non surgical and surgical treatment options;

1. Non surgical Steroid injections and splints (often used in combination).

Steroids are anti inflammatory medicine which we can inject directly into the area of the tunnel. I always mix this up with local anaesthetic medicine so that whilst the initial injection hurts as it is administered the area goes rapidly numb for several hours.

The steroid works by dampening down the irritation and opening up the narrowing of the tunnel to make more space for the tendons to glide in .Often this combined with wearing a splint  for several weeks cures the issues without the need for surgery.

Splints - The splint for De Quervain's  tenosynovitis aims to hold your wrist still and extends up the front surface of your thumb to hold this still also. The logic is if we prevent movement at the wrist and thumb for several weeks we stop the ongoing cycle of irritation which is occurring. Preventing the movement of the tendons through the tunnel for a few weeks alone or in combination with a steroid injection will often overcome the issues without resorting to surgery.


2. Surgery

Surgery is usually reserved for those people who haven't responded to steroid injections and splints .

The surgery is usually a straight forward Day Procedure performed at the hospital.

You usually do not require general anaesthesia. The procedure is performed with local anaesthetic and intravenous sedation so you will not remember the procedure being performed.

You will have an incision on the outside of your wrist several centimetres back from the base of your thumb (at about the level where a watch band may sit).

After the surgery you will have a small scar at this level of your wrist. You will have a bandage and a splint to rest your wrist and thumb for 1-2 weeks ( dictated by how quickly your pain settles). The scar can remain tender for several weeks.

Normally the pain from the Dequervain's  tenosynovitis  settles quickly and you are aware the condition has been corrected within days  even though you have some. residual tenderness from the operation.

Risks: All surgery( however small ) has risks. We minimise the risk of anaesthetic complications by avoiding general anaesthesia wherever possible. This procedure is routinely performed as a local anaesthetic procedure with intravenous sedation for your comfort.

Problems related to DeQuervain's  tenosynoitis surgery are rare. All surgeons who perform this procedure are aware that there are branches of the superficial part of the Radial nerve which run across the area where the surgery is performed and need to be protected to avoid  damaging these. We also are aware that within the DeQuervain's tunnel there is usually individual compartments for each tendon and each of these compartments needs to be released to make sure the surgery is successful.  This will be our focus should you ever require surgery for this condition.

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