De Quervain's Tenosynovitis
What is De Quervain's tenosynovitis ?
De Quervain's tenosynovitis is inflammation of the tendons of the thumb at the base of the wrist. Two tendons are affected: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), which run together through a fibrous tunnel known as the first extensor compartment.
When this tunnel narrows or the tendons become thickened, their gliding becomes painful. The pain is sharp, localised to the radial side of the wrist just above the thumb, and is aggravated by pinching, gripping and all thumb movements. The Finkelstein test (thumb tucked into the palm with the wrist bent toward the little finger) is typically very painful.
De Quervain's tenosynovitis is more common in women, particularly in the post-partum period, and in those performing repetitive thumb and wrist movements.
What is the treatment ?
Conservative treatment is always offered first:
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a thumb spica splint worn at rest
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anti-inflammatory medication during painful episodes
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a corticosteroid injection into the first extensor compartment, which provides effective relief in the majority of patients
Surgery is offered when these measures fail to provide lasting relief, or when symptoms recur rapidly after injection.
How is the procedure performed ?
The procedure is performed under regional anaesthesia on a day-case basis (the patient goes home the same day).
A short incision at the base of the thumb provides access to the first extensor compartment. The compartment is opened to release the tendons.
Both sub-compartments, those of the APL and EPB tendons, are systematically identified and decompressed: an anatomical septum separating the two tendons is frequently present and, if not identified and released, may result in incomplete decompression and persistent symptoms.
This systematic approach significantly reduces the risk of treatment failure or recurrence.
What is the recovery ?
A thumb splint is worn for 15 days after the procedure.
Movement of the interphalangeal joint of the thumb is encouraged from the outset to prevent stiffness. Wound care is carried out for about 2 weeks.
Return to light activities is possible quickly, and to manual work within four to six weeks. Physiotherapy may be prescribed if needed.
What are the risks?
Risks include:
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injury to the superficial branch of the radial nerve, running close to the incision, potentially causing pain or numbness over the back of the thumb
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wound infection
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tendon instability following compartment release, rare but possible
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persistence of symptoms from an unrecognised sub-compartment not fully decompressed