What is De Quervain’s Syndrome?
This is a painful condition that affects the tendons as they pass through a tight tunnel on the radial (thumb) side of the wrist causing pain at the base of the thumb radiating up and down the side of the wrist and into the thumb, particularly with use and grip.
What is the cause of De Quervain’s Syndrome?
The exact cause is unknown, and often no cause is found. The mechanism is clear – the affected tendons pass through a tight fitting tunnel at the base of the thumb – excessive use produces swelling and friction. This in turn makes the swelling worse and the situation is aggravated.
This scenario can be triggered by periods of excessive use, such as intensive gardening, sports, changes of job which require grip. Hormones are also likely to play a role as pregnant or breastfeeding women are particularly prone to this condition.
What are the symptoms?
The condition is characterised by:
- Pain around the base of the thumb radiating up the side of the forearm and down along the thumb. The pain is aggravated by movement of the thumb and with grip
- Tenderness on pressing the affected area (ie the tendons on the side of the wrist near the base of the thumb).
- Unusually, the tender area may be swollen.
What treatment is available?
De Quervain’s tenosynovitis can be self limiting and resolve without active treatment. At this stage, analgesic gels, and especially rest, can be beneficial.
If the symptoms do not improve with lifestyle modification, the first lines of treatment are:
- Splintage: (this immobilises the wrist and thumb): This ensures rest and avoidance of further provocation. It is best if this is customised, made to measure by a therapist. Most splints are made of Thermoplastic material attached with Velcro and can be removes for cleaning and washing. They should be worn whenever the hand is active.
- Injection of steroid into the tunnel. (directly into the tunnel) Steroids cause all tissue to thin and shrink. Placing a small quantity (1ml) of steroid in the tunnel shrinks the tendon lining and this tends to resolve the swelling, reduce the friction and the cycle reverses. This is usually performed in the clinic room. It is not unusual for the pain to be slightly worse on the day of injection and then to improve steadily over a period of three weeks. During this improvement period it makes sense to rest the wrist and thumb, if possible, so as to give the steroid best chance to work. Side effects are unusual but may include thinning of the skin and/or alteration in skin colour (such as a temporary pale patch in dark skin). Your surgeon can talk about this at the time you consent to injection.
- Surgery (release of the tunnel for permanent relief): The aim of this is to lay open the tight tunnel. This provides permanent relief of the friction which caused the pain and swelling. This is usually performed under some form of local anaesthetic and involves a short cut in the skin through which the tunnel is laid open and the tendons allowed to glide freely. This immediately and permanently removes the pressure on the tendons and relieves pain. In principle the hand is out of action for two weeks during which time it needs to be elevated above the level of the heart. The scar can be sensitive for several weeks and there can be temporary numbness which settles over a few weeks.
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