De Quervain's stenosing tenosynovitis is a common cause of pain in the region of the wrist. Patients present with a complaint of pain during use of the hand. The pain is located on the thumb side of the wrist, near the base of the thumb and just above the so-called anatomical "snuff box".
The condition usually starts spontaneous and insidiously; now and again the onset may be associated with strenuous and repetitive use of the hand. The condition is more commonly seen in the middle aged and older group of patients, but can also occur in younger patients, especially females, in the first few weeks after the birth of their baby. The dominant or the non-dominant hand may be affected.
In older patients, the tendons develop short "cracks" or degenerative tears in the length of the tendon, which leads to a localised inflammatory response, with resultant swelling and pain. This localised swelling interferes with the smooth gliding motion of the tendons in question. In females, shortly after delivery, overuse and fluid retention play a significant role.
Local treatment - The application of ice early in the development of the condition may help, as would the application of an anti-inflammatory ointment or patch. Physical therapy may also be of some benefit.
Rest and the use of a brace - a temporary measure that may be of benefit early in the development of the condition but, it limits the use of the hand (the thumb is essential in more than 60% of hand function)
Infiltrating the tendon sheath - Injecting the soft tissue around the tendon sheath with cortisone and a local anaesthetic may temporary manage some of the swelling and pain. Attempting to inject the mixture into the tendon sheath is tricky and may cause harm, if done incorrectly.
If conservative (non-surgical) treatment fails, and the condition interferes with normal daily activities, surgery may be considered.
Surgery to release a De Quervain's is done as a day procedure; i.e., you will be admitted to a hospital or day clinic and discharged the same day.
The surgery performed in an operating theatre and should never be attempted in a consulting room.
It is preferable to perform the procedure under a form of local anaesthetic, called regional anaesthetic. This aims to numb either the whole or at least part of the forearm. In addition to the local anaesthetic, you will also be given a sedative. A general anaesthetic may be used in patients that cannot tolerate a local anaesthetic.
"Cutting time" (from the first incision, to complete wound closure), is normally some 20-30 minutes.
The skin incision is short (approximately 2 - 3cm) and is located over the thumb-side of the wrist, just before the "anatomical snuff box". The surgical incision is normally closed with self-dissolvable stitches. A soft bandage is used to cover the wound, leaving the thumb and fingers free, allowing you to do most essential everyday activities. No plasters or splints that may limit movement of the wrist or fingers, are required.
You may leave the hospital when:
1st Follow-up visit (10 to 12 days after surgery)
2nd Follow-up visit (6 weeks after surgery)
Theoretically it could, but this is seldom seen. An alternative explanation for a so-called "recurrence" is that some patients have more than the average 2 tendons that are involved; one must specifically look for an "additional" or accessory tendon, which may follow a different path through a separate tunnel. If missed and not released, such patients may have persistent pain even after surgery.
Your wound should take about 10-12 days to heal to such an extent that further wound dressings are unnecessary. After that, you should be able to gradually take on more of your everyday activities, and at 3 to 4 weeks you should be able to perform most of your normal activities. By 6 weeks you should be able to perform even strenuous activities.
Do not attempt to drive for the first 18 - 24 hours after surgery, as you are under the influence of the anaesthesia and painkillers; this is a medical and an insurance issue. Driving thereafter depends on your ability to effectively handle a vehicle in normal and emergency situations. If you can drive, you will not cause any harm to the operated hand.
The pain associated with the condition usually becomes so intense and debilitating, that few patients can tolerate it, and most would agree to surgery long before any permanent harm is caused. Theoretically, if neglected, the tendon can either rupture during strenuous activities or it can become stuck down in one position, making the thumb "useless".