De Quervain's Release
This outpatient procedure relieves the symptoms of De Quervain's tenosynovitis by releasing the tendon sheath that wraps around the tendons at the base of the thumb. This relieves pressure and friction on the tendons, allowing them to glide freely.
De Quervain's disease, also known as de Quervain's tenosynovitis, is an inflammation of the two tendons that run from the back of thumb and down the side of the wrist. The disease was first identified in 1895 by Fritz de Quervain, after whom it is named. The swollen tendons and their coverings may cause friction within the narrow tunnel through which they pass. The end result is pain at the base of the thumb.
Conservative treatments for de Quervain's tenosynovitis focus on relieving pain and minimizing swelling through the use of anti-inflammatory medication, corticosteroids, splints and rest. For more severe cases, surgical release of the tight covering of the tendon, known as a de Quervain's release, will make room for the irritated tendons and eliminate painful inflammation.
Causes of de Quervain's Disease
The causes of de Quervain's disease are unknown, but it has been linked to wrist injury, overuse/repetitive motion, pregnancy and inflammatory arthritis. Overuse of the thumb in particular appears to be related to the development of the condition, which may be brought on by participation in such activities as gardening or playing sports that require grasping a racquet, including tennis. Working in certain occupations, such as construction, may also increase a person's risk for de Quervain's disease.
Other causes of De Quervain's disease may include:
- Degenerative disorders, such as rheumatoid arthritis
- A direct blow or injury to the thumb
- Repetitive grasping of an object
Symptoms of de Quervain's Disease
De Quervain's disease causes pain, swelling and tenderness over the thumb side of the wrist, and makes gripping objects difficult. The index finger and the back of the thumb may feel numb, and moving the wrist or thumb can cause a squeaking or creaking sound. Patients with this condition usually feel pain if direct pressure is applied to the area, and may experience swelling or the formation of a small bump on the side of the wrist at the base of the thumb. Thumb movements may also be difficult and painful.
De Quervain's disease can vary in its severity. If the condition is left untreated, pain may become progressively worse and begin to spread beyond the thumb and wrist and into the forearm. For more severe cases of de Quervain's disease, a surgery known as de Quervain's release may be necessary.
Treatment of de Quervain's Disease
Conservative treatments are usually the first approach taken to relieve symptoms of this condition. This may include the use of anti-inflammatory medications, occupational therapy, corticosteroids, wearing splints and resting the affected arm. Surgical de Quervain's release is typically recommended when conservative measures have failed to ease pain.
The de Quervain's Release Procedure
During the de Quervain's release procedure, the doctor will inspect the sheath that surrounds the involved tendon or tendons. The sheath is then opened to relieve the pressure, eliminate pain and inflammation and restore free tendon gliding. De Quervain's release is performed as an outpatient procedure, and generally takes a few hours to complete. Following surgery, a customized exercise program can be highly beneficial to improve the strength of the thumb and wrist.
Risks of de Quervain's Release
Although de Quervain's release is considered a safe procedure, like all forms of surgery, it does carry some risk. The complications associated with this procedure may include:
- Nerve damage
- Blood loss
- Injury to the arteries of the fingers or hand
- Allergic reaction to pain medication following surgery
Some patients may be at greater risk for developing these complications after undergoing a de Quervain's release due to lifestyle factors such as smoking, poor nutrition, a history of alcoholism, past steroid use or age, especially if the patient is older than 60.
Results of de Quervain's Release
De Quervain's release is often successful in relieving a patient's symptoms. In some cases, however, the symptoms of the condition do eventually reoccur. The results of the procedure will vary somewhat, depending on a number of factors including the patient's age, general health and how long the symptoms have been present.