Other popular names
- DeQuervain's tenosynovitis
- First Extensor compartment tenosynovitis
Who does it affect?
Usually adults, slightly more common in females.
Why does it happen?
The tendons on the back of the wrist travel through separate tunnels at the wrist joint. These tunnels are to ensure that the tendons do not bowstring when the wrist is cocked back. The space inside the tunnel is limited and lubricated. If inflammation occurs in the tunnel then the tendons become irritated and cause pain and swelling inside the tunnel. DeQuervain's disease is inflammation of the tendons in the first compartment. This compartment is on the back of the wrist on the thumb side.
Localised pain and swelling on the back of the wrist on the thumb side. This may be accompanied with a sometimes audible "creaking" sensation.
Bending the thumb over into a flexed position reproduces the pain. This test is often called the Finklestein's test.
Usually none, however an ultrasound scan can visualise the inflammation.
A steroid injection into the sheath may lubricate and also damp down the inflammation. Steroid injections can be repeated as long as they continue to give benefits. When further attempts fail to give benefits, surgery is advised.
It is essential for injections to be performed anatomically correctly by an experienced surgeon, fully knowledgeable of the fine inner structures of the hand such as the nerves and tendons.
Surgery is done as a day case procedure under regional anaesthetic and takes about 10 minutes. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. It is quite tight, but well tolerated for up to 20 minutes.
The surgery is performed through a 2cm transverse skin crease incision
Local anaesthetic is given. Once numb the skin is cut and then the underlying fat is retracted. Care is taken not to injure sensitive nerves and blood vessels. At the base of the wound is the extensor compartment sheath. This structure needs to be released to allow the tendon and its nodule to glide in and out without catching. Occasionally multiple small sub compartments need to be released. The skin is sutured (stitched) and a bulky dressing is applied.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. The dressing is removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures (stitches) are removed at about 10 days. You should notice an improvement in symptoms within a few days but the final result may take upto 3 months.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work: Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms results in less than 1% of patient. This may be due to failure to completely release all the tendon sub sheaths. It is rare and may need to be released again.
- The nerves just under the skin are notoriously sensitive, if damaged a painful neuroma can develop. Extra care is taken with these nerves to keep this risk to a minimum.