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De Quervain's Disease

De Quervain's disease is an inflammation of tendons on the back of the wrist which enables the thumb to extend. The pathology is generally tightening of the sheath through which the tendons go and this makes the membranes surrounding the tendons (called synovium) inflame and give pain. De Quervain's can generally be treated by injections and is successful in 60% of cases. If the injection doesn't help then a simple de Quervain's release is the next stage.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

There is an incision made over the base of the thumb just over the bony end of the radius. Skin flaps are raised particular care is then taken with the branch of the radial nerve which goes right over the operation site. This is identified and avoided. The sheath that encloses the two tendons is then cut longitudinally round through the middle. If the tendon sheath is cut too much towards the palmar side or too much to the dorsal side this could mean there may be a possibility that the tendons will sub-lux (or flip over) to either the dorsal or palmar side which can give problems post-operatively. It is also vital to identify all the tendons, one of the tendons to the thumb particularly can have more than one strand and there can more than the standard two compartments. If all of the compartments are not released then the symptoms will not be relieved. At the end of the procedure the wrist joint is bent backwards and then palm wards at its extremes to ensure that the tendons do not flip backwards or towards the palm. The skin is then closed.

POST OPERATIVELY

Simple sticky dressing applied over sutures and bulky bandage applied over this. The patient can go home the same day in a high arm sling. This should be maintained for 48 hours when the sling and bandage can be removed and the thumb mobilised. The patient is reviewed in outpatients at two weeks and sutures are removed and physiotherapy may be required.

Return to Work

Patient can return to work anytime between 1 - 3 weeks following surgery.

COMPLICATIONS

  1. Infection - this is rare at less than 1%; infections in the hand are less common than anywhere else because of its increased blood supply.
  2. Nerve damage - to the radial nerve can occur and can leave numbness over the thumb side of the back of the wrist. If the nerve is cut then it can cause more damage and pain than the patient experiences pre-operatively.
  3. Tendon sub-luxation - if the tendon sheath is not cut in the correct place then the tendons can sub-lux (flip).
  4. Complex regional pain syndrome