De Quervain’s syndrome is a painful condition affecting the two tendons that control movement of the thumb. Swollen tendons and their protective coverings, called sheaths, begin to rub against the narrow tunnel through which they pass. De Quervain’s syndrome occurs when the tendons around the base of the thumb become irritated or constricted.
The symptoms of de Quervain’s syndrome vary according to the severity of the disease. Severe pain, tenderness and swelling affect the thumb side of the wrist. The pain usually starts at the base of the thumb and radiates to the wrist and lower arm. Weakness and pain can cause difficulty with normal use of the wrist and thumb, such as gripping, grasping or making a fist.
If de Quervain’s syndrome is not properly treated, normal movement of the hand, wrist and thumb can lead to a limited range of motion. Many doctors choose nonsurgical options as the first treatment choice. You may be placed in a wrist and thumb splint to immobilize your hand. You may be prescribed anti-inflammatory medications to reduce the swelling and pain. Corticosteroid injections may be administered directly into the tendon sheath. If conservative treatment is unsuccessful, your doctor may refer to you a hand surgeon specializing in tendon release surgery.
The goal of hand surgery for de Quervain’s syndrome is to create additional space for the tendons to prevent them from rubbing on the inside of the tunnel. Most procedures are performed on an out-patient basis with local anesthesia and sedation. General anesthesia or regional anesthetic blocks can also be used. Sometimes called a nerve block, the injection of medications, such as lidocaine or novocaine can block nerves for several hours. Doctor Salerno may recommend an axillary block to deaden your entire arm or a wrist block to deaden only your hand.
Doctor Salerno will make a small incision along the thumb side of your wrist. After the tendons and tunnel are located, another incision is made to open the top of the tunnel in order to create additional space for the tendons to pass. Your skin incision will be closed with sutures and your hand will be securely wrapped in a soft, bulky dressing to protect it from bumping against objects. Your body will form scar tissue to fill the gap where the roof of the tunnel was opened.
Full recovery from hand surgery may take several months. You may be placed in a hand splint during recovery. Although the pain and swelling will subside after the surgery, your hand and wrist may be tender for several weeks or months. Your surgeon will prescribe a course of physical therapy to help you regain full use of your hand.
Contact Real Cosmetic and Plastic Surgery to schedule an appointment with Dr. Salerno, an experienced hand surgeon. He can examine you, perform diagnostic tests and discuss surgical treatment for your de Quervain’s syndrome. We can thoroughly explain the surgical procedure and anesthesia options. You will be provided with information outlining what to expect during your recovery and rehabilitation from hand surgery.