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De Quervains disease

Stenosing tendovaginitis

This is a condition that causes pain at the base of the thumb and the outer side of the wrist as a result of narrowing of the tunnel through which some of the extensor tendons pass . As tendons pass to the thumb, they pass deep through a tunnel created by a ‘U’ shaped fibrous sheath that is attached to the bone. In this condition the sheath thickens narrowing the tunnel. As the thumb moves the tendon rubs against the sheath and this causes pain.

 

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What may I notice or complain of?

You may have pain and tenderness on the outer side of the wrist.

The symptoms can be brought on by normal activities which require use of the thumb such as lifting.

Spreading the fingers including the thumb can be painful. Bending the inner side of the wrist downwards also reproduce the pain.

 

How is it treated?

There are many ways that are used to help relieve symptoms. These include splinting of the thumb and anti inflammatory drugs.

Local steroid injection has been shown to be very effective in about three quarters of patients and may require up to three injections at 6 weekly intervals.

A reduction of the activity that worsens the symptoms is necessary to enable the treatments take effect.

Hand therapy (physiotherapy) is also useful.

Surgery – this is the definitive treatment and is recommended after failed non surgical treatment or in presence of severe symptoms and signs.

Anaesthesia

This is usually performed under local anaesthesia. It is done as a day case so the patient can go home the same day.

 

What to expect post operatively

The operated hand is placed in a bulky dressing with the fingers free.

You can reduce the dressings in 5 days and place a simple plaster over the area.

Hand therapy is useful and one or two sessions may suffice. 

Usually there are no stitches to remove as they fall off themselves after a week.