What is De Quervain’s Tenosynovitis?

The tendons of Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) are located over the side of the wrist, where they pass through a tunnel (tendon sheath).  These tendons pull the thumb up and out, as if trying to stretch out around a large object.  The tendons do not have much room to glide within the sheath, and if the sheath becomes inflamed and thickened, the tunnel can become narrowed, causing pain on movement of the thumb and associated swelling.

What can be done?

The best treatment initially is anti-inflammatory medication, rest from any activity that worsens the inflammation, and often a splint, which must include the thumb.  Hand therapy is helpful to stretch the tendons and reduce the inflammation.

If rest, therapy and splinting fail to help then the next step in treatment is a steroid injection.  This is helpful in around 60-80% of cases and can be repeated one or two times. This is a very low risk procedure and can be performed by Mr Murray in clinic. One small risk of injection is a thinning of the skin over the injection site, which can make the skin appear pale.

If the symptoms persist despite steroid injection, then an operation to release the sheath may be indicated.

What does the operation involve?

The operation can be performed under local or general anaesthetic.  A tourniquet (like a blood pressure cuff) is worn on the upper arm during the procedure to prevent bleeding.

One small incision is required, approximately 2cm on the back of the wrist.  The EPB and APL tendons are located, and the tunnel is fully released around the tendons.

The wounds are closed with a dissolvable suture, and a soft bandage applied.

What happens after the operation?

The operation is performed as a daycase procedure, with a hospital stay of just a few hours.  Following the procedure you are advised to elevate the hand for 12 – 24 hours.

After 2-3 days the bandages can be removed, and the wound covered with a simple dressing. Sutures are removed between 10 and 14 days.

Over the next few weeks, our hand therapist will supervise a carefully graduated exercise programme to allow increasing strengthening and movement, whilst protecting the released tendons from further inflammation.

Are there any risks?

This is generally a very safe and effective procedure, with few problems. However, there are a few potential risks, as with any operation.

• Wound infections occur in less than 1% of cases, and usually quickly resolve with antibiotics.
• The scar may be tender.  This usually improves with scar massage.
• There can be some stiffness in achieving full flexion of the thumb into the palm.  This usually improves with hand therapy, and further treatment is not generally needed. 
• Numbness over the back of the thumb, caused by damage to a branch of the nerve.
• Chronic Regional Pain Syndrome “CRPS”.  This is a rare but serious complication, with no known cause or proven treatment.  The nerves in the hand “over-react”, causing swelling, pain, discolouration and stiffness, which very slowly improve.
• Very rarely, the condition can recur, and the operation needs to be re-done.
• Any operation can have unforeseen consequences and leave a patient worse than before surgery. This is rare for De Quervain’s tendon release.