De Quervain's disease
Patients report relatively severe pain at the base of the thumb across their affected wrist. This pain is worse with activities that involve pinching with the thumb or bending the wrist.
This is thought to be caused by irritation of the soft tissues adjacent to two tendons (extensor pollicis brevis, and abductor pollicis longus) as they pass through a tunnel of fibrous tissue on the edge of the wrist at the base of the thumb.
The condition is reportedly more common in women who have recently given birth, and in diabetics. It can be made worse by repeated activity.
The diagnosis can be confirmed in clinic by examination, but in some patients an ultrasound scan might be requested to help confirm the diagnosis.
Most patients with mild symptoms can avoid acitivity that might cause the pain, use oral or topical anti-inflammatory medication (if tolerated), and use a splint to rest the thumb (the splint should extend as far as the thumb inter-phalangeal joint). Most episodes of De Quervain's disease resolve over a period of weeks or months.
If the symptoms persist, or if the pain is severe: a steroid injection in clinic is successful in reducing symptoms in 8 in 10 patients. There is a small risk of a change in colour of the skin after steroid injection ( this usually resolves within a period of months).
Surgery is appropriate for patients who have not got better with a change in activity, rest, splinting, and steroid injection. The operation is usually performed under local anaesthetic as a day case procedure. The procedure usually takes about 30 minutes. A small cut is made at the base of the thumb. The fibrous roof of the tunnel, causing the pain, is divided to allow the tendon to glide freely. The wound is closed with stitches. the operation is successful in about 8 out of 10 patients.
Risks of surgery
- there is a small risk of lingering pain
- there is a small risk of infection
- there is a small risk of irritation of the nerves at the base of the thumb, causing either pain, or numbness. I would estimate this risk to be less than 5 in 100
- with any hand surgery there is a small risk of persisting of a collection of symptoms affecting the whole hand including stiffness, swelling, numbness, and sensitivity this is referred to as complex and regional pain. This is a frustrating and difficult condition which can require weeks, or months of hand therapy, and the involvement of a pain specialist.
- there is a tiny risk of patients will feel some unnatural movement of the tendons at the wrist after surgery. If this is a source of frustration, may require further surgery
Return to activity
Most patients can return to driving within 1 week. Most patients can return to competitive sport within about 4 weeks.