There are many different tendons that run over and under the wrist. These tendons allow for our fingers and wrist to bend and straighten. Each tendon has a unique location and function. DeQuervain’s tenosynovitis affects the abductor pollicus longus and extensor pollicus brevis tendons which help control thumb motion. DeQuervain’s tenosynovitis is a common tendon issue in the wrist and can affect patients both young and old. Patients may complain of pain when lifting their newborn, often referred to as “Mommy thumb”, others may notice the pain while doing repetitive lifting at their job or while doing housework, and some may notice the pain while texting or using their phone.
Patients generally present with pain over the thumb side of the wrist. This area is called the first dorsal compartment of the wrist. This compartment contains the abductor pollicus longus and extensor pollicus brevis tendons. There may be visible swelling directly over this area and it may be tender to touch. Inflammation of the soft tissues surrounding the tendons in this compartment may cause narrowing and pain. Pain will commonly be elicited with any kind of lifting, pinching, or grasping activity in ulnar deviation and with the use of the thumb. Our doctors can usually make a diagnosis on physical examination alone. Once the diagnosis is established they will discuss the different treatment options.
Generally, initial treatment involves immobilization of the wrist and thumb with a soft brace. These thumb spica braces are available in our office or a custom brace may be made by a hand therapist. The brace allows the tendons to rest, helps alleviate pain, and hopefully decreases inflammation in that area. It is also common that a cortisone injection will be offered at your initial appointment. The cortisone is injected directly into the first dorsal compartment and surrounding the affected tendons. Cortisone is a steroid that works to decrease inflammation in that area. Patients will usually feel relief within a couple of days after the injection. If the pain does not respond to the cortisone injection or recurs, then surgical intervention may be indicated.
Surgical treatment for DeQuervain’s tenosynovitis is a straightforward and quick treatment although our doctors will continue to take the utmost care during this procedure. The procedure can be done under local anesthesia in a hospital or ambulatory surgery center. This means that a numbing injection will be given into the area of the wrist where the surgery is done, but otherwise you will be awake. You will not feel any pain and by avoiding general anesthesia you will not need to spend extra time in the recovery room time once the surgery is over. If you have any concerns about being awake during the procedure you can certainly discuss with you doctor other options.
During the surgery an incision is made over the thumb side of the wrist. The first dorsal compartment will be identified and released to open the tunnel and free the tendons. After surgery, a splint may be applied for about one week to rest the wrist. After one week, you will follow up in our office and the splint will be removed. At this point, you will begin to regain your motion and strength with a series of hand and wrist exercises. Generally these exercises can be done on your own at home, although formal physical therapy may also be recommended. Recovery generally takes two to three weeks, and you can return to most activities as tolerated within that time.
DeQuervain’s tenosynovitis can be extremely frustrating and cause serious setbacks and dysfunction for patients. Our goal at TOC is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any wrist issues and receive superior care from our doctors and staff.
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