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DE QUERVAIN’S TENOSYNOVITIS (STENOSING TENOSYNOVITIS)


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

The condition is poorly understood. The tunnel (first dorsal extensor compartment) wall gets thickened and the space for the two tendons to move through, gets smaller. This friction causes synovitis (inflammation of the tendon sheath) and thickening of the tendon, aggravating it further.

Pain is felt over a very specific place on the radial (thumb) side of the wrist and certain movements like wringing out a cloth or picking a child up under their arms, aggravates the pain.

Treatment involves avoidance of aggravating motions, splinting (poor response generally) and steroid injections. Steroid injections tend to work well in about 80% of people. These injections, especially multiple ones, have the potential side effects of decolouration and fat atrophy of the skin at the injection site. Surgical treatment becomes an option if conservative treatment fails, and is based on releasing the sheath of the first dorsal compartment and freeing the tendon from degenerative tissue.

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Rehabilitation post De Quervain’s release

The wrist is immobilised in a cast for 10-14 days to allow the wound and soft tissues to heal. Immediately post surgery it is important to keep the hand elevated, the cast dry and to gently exercise the thumb to keep the tendons gliding through the recently released tunnel.

When the cast is removed, the wound will be checked and a light dressing reapplied. A wrist and thumb splint is fabricated to wear for the following 2 weeks. This splint must be removed 5 times a day for thumb and wrist exercises, but provides support and pain relief when using the hand. Therapy will include swelling and scar management, wrist and thumb range of movement and strengthening.

The thumb and wrist will likely still be recovering at 6 weeks post surgery, but should be well healed after 3 months


icon-5

DE QUERVAIN’S TENOSYNOVITIS (STENOSING TENOSYNOVITIS)


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

The condition is poorly understood. The tunnel (first dorsal extensor compartment) wall gets thickened and the space for the two tendons to move through, gets smaller. This friction causes synovitis (inflammation of the tendon sheath) and thickening of the tendon, aggravating it further.

Pain is felt over a very specific place on the radial (thumb) side of the wrist and certain movements like wringing out a cloth or picking a child up under their arms, aggravates the pain.

Treatment involves avoidance of aggravating motions, splinting (poor response generally) and steroid injections. Steroid injections tend to work well in about 80% of people. These injections, especially multiple ones, have the potential side effects of decolouration and fat atrophy of the skin at the injection site. Surgical treatment becomes an option if conservative treatment fails, and is based on releasing the sheath of the first dorsal compartment and freeing the tendon from degenerative tissue.

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Rehabilitation post De Quervain’s release

The wrist is immobilised in a cast for 10-14 days to allow the wound and soft tissues to heal. Immediately post surgery it is important to keep the hand elevated, the cast dry and to gently exercise the thumb to keep the tendons gliding through the recently released tunnel.

When the cast is removed, the wound will be checked and a light dressing reapplied. A wrist and thumb splint is fabricated to wear for the following 2 weeks. This splint must be removed 5 times a day for thumb and wrist exercises, but provides support and pain relief when using the hand. Therapy will include swelling and scar management, wrist and thumb range of movement and strengthening.

The thumb and wrist will likely still be recovering at 6 weeks post surgery, but should be well healed after 3 months


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