De Quervain's disease R6

This disabling tendinopathy is a degenerative condition affecting two tendons (abductor pollicus longus and extensor pollicus brevis) on the thumb side of the forearm. It is seen predominantly in females during child bearing age as well as pre-menopausal women.

The condition basically affects the synovial sheath of these tendons. As the tendons become thicker and swollen, the space in the tunnel that keeps them close to the bone (first dorsal extensor compartment) becomes smaller (stenosis). There is less space for the tendons to glide freely, and this aggravates the pain and symptoms.

Symptoms

Pain is felt over a very specific place on the radial (thumb) side of the wrist and certain movements like picking a child up under his arms, aggravates the pain. Often wringing and pinching causes pain.

Finkelstein’s test (where the thumb is passively flexed and the wrist moved into ulnar deviation) causes significant sharp pain over the radial side of the wrist.

Postion of Pain

Finkelstein’s test

Pain is felt over a very specific place on the radial (thumb) side of the wrist.

Treatment

Treatment comprises avoidance of aggravating motions, splinting (poor response generally) and steroid injections. Steroid injections tend to work well in about 60% of people. These injections, especially multiple ones, may have the side effects of discolouration of the skin and fat atrophy of the skin at the site of injection.

Surgical treatment is an option if conservative treatment fails and is based on releasing the sheath of the first dorsal compartment to create space for free gliding of the tendons.

Steroid injections tend to work well in about 60% of people.

The Surgical Incision for De Quervains release

Expectations after the Operation

Potential Complications

  1. The superficial branch of the radial nerve can be injured during the surgery but this is exceedingly rare.
  2. There might be delayed wound healing or wound infection (<1.5%).

Rehabilation after the Operation

Exercises

Active Wrist Exercise

Active Thumb Exercise

Active Thumb Exercise