De Quervain’s Tendonitis
De Quervain's tendonitis affects the tendons on the thumb side of the wrist, causing pain with thumb and wrist movement. It occurs when the sheath surrounding the abductor pollicis longus and extensor pollicis brevis tendons becomes thickened, preventing smooth tendon gliding. De Quervain's is more common in women, particularly during or after pregnancy, and in those who perform repetitive thumb and wrist movements. Conservative treatment is tried first, with surgery recommended when this fails.
What does the treatment for De Quervain's tendonitis involve?
Your surgeon will assess your symptoms, palpate for tenderness over the radial styloid, and perform Finkelstein's test - passive ulnar deviation of the wrist with the thumb tucked inside the fingers, which produces sharp pain in De Quervain's. X-rays may be taken to exclude arthritis or other bony pathology.
Conservative treatment includes rest, a thumb spica splint for four to six weeks, anti-inflammatory medication, and corticosteroid injection. Injection is very effective, providing relief in sixty to eighty per cent of cases.
If conservative treatment fails, surgical release takes twenty to thirty minutes under local anaesthetic as a day case. A small incision over the radial side of the wrist carefully exposes the first dorsal compartment, protecting nearby sensory nerve branches. The compartment is opened along its full length, and any internal septations are released to ensure all tendon slips are decompressed. Immediate movement is encouraged.
Your Recovery
Pain relief is usually immediate once the tendons are decompressed. Incision soreness is expected for five to ten days. Sutures are removed at ten to fourteen days. Light activities are possible immediately; repetitive thumb use should be avoided for two to three weeks. Desk work is possible within a few days, and full recovery typically occurs by four to six weeks.
Risks and Complications
Nerve injury causing numbness on the back of the thumb (superficial radial nerve branches are at risk)
Painful neuroma if nerve is injured
Incomplete release if septations are missed
Tendon subluxation if too much compartment is released (rare)
Scar tenderness
Persistent pain if diagnosis was incorrect or a coexisting condition is present
Frequently Asked Questions
Should I try an injection before surgery?
Yes. Corticosteroid injection is highly effective (sixty to eighty per cent success rate) and is considered first-line treatment after splinting. Most surgeons recommend at least one injection before proceeding.
Will De Quervain's come back after surgery?
Recurrence after complete release is very rare. The vast majority of patients have permanent resolution of symptoms.
What causes De Quervain's?
Repetitive thumb and wrist movements are a common trigger. It is particularly common in new mothers from repetitive lifting and holding of babies, and in heavy smartphone users.
THE SPECIALIST CLINIC DUBLIN
Plastic, Reconstructive & Aesthetic Surgery performed with Care & Compassion
To discuss De Quervain's tendonitis treatment, contact us to arrange a consultation.