De Quervain’s Syndrome

Why does it occur?

It will often occur without any obvious cause. The pain and discomfort may worsen during hand use at work and at home. It is due to some of the tendons which enable movement of the thumb becoming inflamed as they move within the sheath (tunnel) which tethers them to the bone.

What are the symptoms?

Pain, swelling and tenderness on the thumb side of the wrist. Certain movements may exacerbate pain - for example using scissors. 'Clicking' of the tendons occasionally occurs.

Investigations

A diagnosis is made from the clinical history and examination.

X-rays may be taken to exclude arthritis in the wrist or thumb.

Treatment options

  • Non-operative treatment

Rest - the symptoms may resolve if painful activities can be avoided.

Splinting - to immobilise the thumb may assist in relief of symptoms leading to resolution of the condition.

Steroid injection - targets the source of the discomfort to reduce inflammation in the localised area.

  • Operative treatment

A De Quervain's release is a short day-case procedure which is usually performed after a local anaesthetic injection to numb the area. An incision is made over the site of the discomfort and the tendon sheath is released. The tendons will be observed to ensure freedom of movement. The wound is sutured. Dressings are applied to cover the site.

Complications

Nerve or blood vessel injury - despite all care being taken there is a small risk of damage to the small nerves and vessels running under the skin. This could lead to numbness in the area of the scar and its surroundings which may be permanent.

Chronic Regional Pain Syndrome Type 1 - (incidence of 1 %) this condition can occur after injury or surgery and would mean more pain and stiffness which would require analgesia and hand therapy.

Scar - this should become less obvious over time.

Rehabilitation after surgery

The dressings can be reduced after 24 hours but the stitches must remain covered until they are removed 7-10 days after surgery. The site should be kept clean and dry during this period. There are no restrictions upon movement.

Frequently asked questions

When can I drive a car?  The wrist should be comfortable to allow driving in a few days. You should be certain that you will be in full control of your vehicle before driving after wrist surgery.