What is De Quervain's Tenosynovitis
De Quervain’s Tenosynovitis is a painful inflammation of tendons on the side of the wrist at the base of the thumb.
Local Orthopedic Surgeon
Dr. Bertrand Perey, MD, FSRC, Orthopaedic Surgeon, talks about De Quervain’s Tenosynovitis and what to expect if you are diagnosed with the condition
Dr. Bertrand Perey, MD, FSRC, Orthopaedic Surgeon, talks about De Quervain’s Tenosynovitis and the various treatment options available.
Understanding De Quervain's Tenosynovitis
De Quervain’s Tenosynovitis is a painful condition that affects the tendons on the radial (thumb) side of the wrist. The condition affects the tendons that move the thumb. It is particularly noticeable when trying to bend the thumb, especially when the thumb is being bent in a sideways direction towards the small finger. It can also cause pain when trying to lift the thumb, such as the action of performing a hitchhiking action.
De Quervain’s Tenosynovitis is usually caused by spontaneous swelling of the tunnel that carries two of the tendons that go to the thumb. This can be caused by trauma but it is usually spontaneous and unrelated to an injury. It is more common in patients in the fifth decade of life but it can occur in younger patients, especially in mothers with a newborn child. A relatively minor injury can occasionally precipitate this condition, although to become symptomatic from this condition, one usually has to be a person at risk to develop this entity.
Most patients who suffer from this condition usually have pain and swelling noted in the radial aspect of the wrist. This is the thumb side of the wrist, where the extensor tendons to the thumb reside. The pain may appear either gradually or with a sudden onset. The pain is usually aggravated with use of the thumb, especially when attempting to flex the thumb into the palm, or when trying to lift the thumb into terminal extension. Pain can radiate up the forearm into the elbow.
Local Practitioners: Orthopaedic Surgeon
The treatment of De Quervain's Tenosynovitis
The first line of treatment should be the modification of activities that cause pain and/or splinting. Splints usually involve immobilization of the wrist and the thumb. Anti-inflammatories can be of benefit to help reduce swelling and relieve pain. If the problem fails to resolve within several weeks, then a corticosteroid injection is usually recommended.
Cortisone injections may cause transient depigmentation of the skin around the injection site. This is particularly prominent in patients with darker skin or during seasonal exposure to sunlight. Furthermore, cortisone can cause thinning of the skin making the underlying anatomy more visible. Usually these conditions do resolve with time but, on occasion, depigmentation and thinning of the skin can be permanent.
This corticosteroid injection is performed right over the tunnel carrying the tendons to the thumb. Improvement in symptoms is usually felt between three and seven days following the injection. This usually continues to improve for six to eight weeks. The majority of patients that receive a corticosteroid injection for De Quervain’s Tenosynovitis have complete, or near complete, resolution of their symptoms within two months.
Unfortunately, up to 1/3 of patients can have recurrence of their symptoms, despite improvement following a cortisone injection. A second cortisone injection maybe recommended. Depending on the severity and chronicity of the problem, a second cortisone injection may be considered. Patients with diabetes, or those with more advanced and chronic symptoms, will likely have a higher rate of failure with cortisone alone. Failure to obtain permanent resolution of symptoms with corticosteroids would usually lead to surgical treatment.
Surgical treatment involves opening of the tendon tunnel to the thumb and is usually done with a local anaesthetic, in an ambulatory care setting. Although surgery is usually successful in permanent resolution of symptoms, the recovery from surgery is slower than the recovery from the cortisone injection. It is very common for patients to experience transient numbness into the thumb and hand, following surgery, but this usually does resolve with time.
The wound is usually dressed for 48 to 72 hours after surgery, at which point the wound may be washed with soap and water. Patients are asked to avoid soaking or a dirty environment for 10 to 14 days. The surgical site usually becomes harder over six weeks and a course of deep massage, after two weeks, is usually encouraged to soften the scar and ease the tenderness. This scar reaction to surgery can often become more significant over the first six weeks after intervention.
Wound infections can occur after surgery and occasionally may require a course of oral antibiotics. Persistent numbness in the finger after surgery is usually caused by an injury to the radial nerve. This will, more likely than not, resolve with time.
Local Practitioners: Orthopaedic Surgeon