de Quervain's Disease
What is de Quervain's disease?
The mechanism that allows you to move your thumb consists of a number of muscles, each connected to a tendon (sinew). The tendon provides the link between the muscle (placed in the forearm where there is more space) and the bone in the finger to which it is attached.
To pass across the wrist the tendons run in a sheath. This is designed to provide lubrication for the tendons to allow them to glide with a minimum of friction. This sheath is strengthened by pulleys. The pulleys keep the tendon in the ideal position, close to the bone.
In de Quervain’s disease (de Quervain’s tenovaginitis stenosans) the sheath becomes thickened. The tendons no longer run smoothly. They catch on the sheath and this is painful.
What treatment is available?
There are three main types of treatment:
1. Some cases will respond to rest, a splint and anti-inflammatory tablets.
2. Injection. The surgeon injects a small amount of locally active steroid (cortisone) next to the point at which the tendon is catching. This can be successful, especially in early cases. There are small risks of infection, of nerve and tendon injury and of thinning of the skin overlying the injection site. This will be successful in roughly 50% of cases. Sometimes we ask for this injection to be given under ultrasound control.
What will the surgery aim to do?
The pulley is opened up to allow the tendons to pass freely. The surgery is normally carried out under local or general anaesthetic as a day case.
What kind of scar will I have?
All surgeons make a slightly different incision. This incision can be straight or in a zigzag pattern over the wrist. You will have stitches in the wound and a bulky dressing. The stitches will be removed 10 to 14 days after the operation.
What should I do after the operation?
Your hand will be bandaged. A bulky bandage is not usually needed for long. You can then start to move your finger actively. We recommend that you routinely take painkillers for 48 hours after the operation. After this, take painkillers as required. If at this stage you have increasing pain you should seek medical advice. Later on you may need a few sessions of physiotherapy
Do I need to do anything else?
You should move your fingers as soon as possible. When the stitches are removed, massage the wound with cream (E45, Neutrogena, Atrixo). Keep the wound dry.
How long will I be off work?
Desk job: Two weeks at most
Light manual: Four weeks
Heavy manual: Four to six weeks
Driving: On average one week
What complications can occur?
This surgery is normally safe and trouble free. The risks of complications are low. They include infection, abnormal and prolonged pain response (CRPS), nerve and tendon injury, recurrence, inflammation and prolonged swelling.