De Quervains Disease
What may I notice or complain of?
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?
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.
What are some of the problems that may arise?
Infection can occur as with any surgery and is usually treated with antibiotics.
Collection of blood under the skin (haematoma) can occur especially in patients on aspirin or warfarin. It can usually be drained without much difficulty.
The scars may be tender or sensitive. Massage with cream does help and it settles with time.
The released tendons can ‘sublux’ or move from side to side often with a click when the thumb is moved. Reassurance usually suffices. Occasionally another operation is required to stabilise the tendons.
Neuroma or a painful lumpy scar in the nerve can occur. This may require another operation to correct.
Very few patients may react abnormally to surgery and develop a condition called complex regional pain syndrome which can cause pain and stiffness of the fingers. The aim is to detect the early signs and treat it before it becomes a major problem.