De Quervain’s Disease fundamentals
De Quervain’s disease is a painful inflammation of specific tendons that extend the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain that may extend from the forearm to the thumb base. De Quervain’s was named after the Swiss surgeon who first described the condition in 1895. It is one of the most common types of tendon lining inflammation (also called tenosynovitis).
What causes De Quervain’s Disease?
Overuse, a direct trauma or injuries to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports, and various workplace tasks are some activities that can aggravate the condition. It is also seen during the last trimester of pregnancy and in mothers of nursing children. Often, its cause is unknown. De Quervain’s affects women eight to 10 times more often than men. People who engage in activities that require sidewise motion of the wrist while gripping with the thumb (e.g., hammering, skiing) may be more likely to develop the condition.
Pain along the back of the thumb, directly over the two thumb tendons – the extensor pollicis longus brevis and the abductor – is typical of de Quervain’s. The condition can occur gradually or suddenly. In either case, the pain may travel into the thumb or forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects. Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people also feel pain if direct pressure is applied to the area.
The test most frequently used to diagnose de Quervain’s disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. When the wrist is suddenly bent to the little finger side (as in casting a fishing pole), the swollen tendons are pulled through the tight space. If this maneuver is very painful, it is likely that you have de Quervain’s disease. Arthritis and other forms of tendonitis may also cause symptoms in this area.
What are the benefits of treatment?
The main benefits of treatment are to alleviate the pain associated with the condition and improve mobility and function. Treatment usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area and refraining from any activities that may aggravate the condition. Ice may also be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication – which may be taken orally or injected – to reduce swelling. If de Quervain’s disease does not respond to conservative medical treatment, surgery may be recommended.
What are the risks and complications of surgery?
Risks include nerve injury, infection, bleeding, stiffness of thumb, recurrence, pain or numbness at the incision.
How do I prepare for surgery?
Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
- Main Campus: 216.444.0281
- Beachwood: 216.839.3500
- Refrain from eating or drinking anything after midnight the night before surgery.
Are there exercises that I can start now prior to surgery?
Maintain thumb range of motion as your comfort level allows.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens during surgery?
Surgery for de Quervain’s is an outpatient procedure and is usually done under local anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendons’ smooth gliding capability.
During surgery, additional procedures may be conducted to remove inflamed tissues or small cysts.
What happens after surgery?
The wound is closed and a compressive dressing is applied. Early on, a splint is used for comfort. The doctor typically prescribes pain medication as well as a therapy program for increasing the strength and range of motion of the thumb and wrist.
Ask your surgeon for complete post-operative instructions.
How long is the recovery period after surgery?
Recovery times vary, depending on your age, general health, and how long the symptoms have been present. Light use of the thumb is possible immediately with a progressive return of range of motion and strength over the next few weeks.
What is the rehab after surgery?
Rehabilitation involves range of motion exercises to prevent stiffness and swelling and to gradually restore hand and wrist motion. Next, progressive strengthening gradually improves the function of the hand.
How can I manage at home during recovery from the procedure?
You must wear a splint, and you may be able to shower. Ask your surgeon for complete instructions.
How frequently should I schedule follow up appointments with my doctor following surgery?
Please check with you surgeon, as this varies from case to case.
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