De Quervain Syndrome - Harley Clinic

De Quervain’s syndrome is a painful condition that affects the tendons on the thumb side of the wrist.

De Quervain’s Syndrome Surgery Overview

What is De Quervain’s Syndrome?

Pain in your thumb could be a symptom of De Quervain’s syndrome. Other names for the condition include:

De Quervain’s tenosynovitis
De Quervain’s disease
De Quervain syndrome
Gamer’s thumb (nickname)
De Quervain’s tendinitis

In your hand, your muscles and bones are connected by a thick tissue called tendons. These tendons are then covered by a thin sheath. The two tendons located on either side of the thumb are called:

Extensor pollicis brevis(EPB)
Abductor pollicis longus (APL)

These tendons help you to bring your thumb away from the index finger and straighten the thumb.

When the tendon sheath is inflamed and swollen, it can put a lot of pressure on the surrounding area. It’s the pressure on the tendons that can cause irritation and swelling. This can lead to a condition known as De Quervain’s Syndrome. So, the condition refers to inflammation of both tendons and their sheath.

The name of the condition comes from the Swiss surgeon Fritz de Quervain, who first described the condition back in 1895.

What are the Symptoms of De Quervain’s Syndrome?

Naturally, symptoms of De Quervain syndrome focus heavily on the wrist side of the thumb. If the condition is left unchecked, the pain can get worse and begin to include more of the thumb and forearm. That’s why it’s important to get it checked out by a doctor if you have any concerns.

De Quervain syndrome symptoms include:

Swelling and pain at the back of the thumb
Difficult moving your wrist and thumb
It may be painful and swollen on the side of the wrist
Tenderness when pressing on the pain site
Clicking or snapping of tendons happens occasionally
Pain becomes worse when you lift the thumb
May feel pain is more noticeable when forming a fist, gripping, twisting the wrist, or lifting with arms in front of you (e.g. lifting a child)

What are De Quervain Syndrome Causes?

The two tendons that connect the wrist and lower thumb normally glide through a tunnel (sheath) without a problem. When those tendons repeatedly perform the same action, it can irritate the tunnel or sheat. This irritation can cause the sheath to swell and thicken, which restricts movement.

The exact cause of De Quervain’s syndrome is unknown, but it’s thought that some activities can aggravate the pain.

In many cases, it can occur without a clear cause. Mothers with young babies appear to be more prone to the condition. This could be due to hormonal changes or an increase in lifting the baby repeatedly; it’s not completely clear yet.

De Quervain risk factors include:

Overuse
Injury to the thumb
Repetitive movement like grasping
Inflammatory conditions such as arthritis

Certain activities require a specific sidewise wrist motion while gripping with the thumb. This motion could worsen the condition. Activities that use a sidewise wrist motion include:

Gardening
Racquet sports like tennis
Lifting young children
Skiing

What is the Difference Between De Quervain’s Syndrome vs Carpal Tunnel?

De Quervain’s syndrome and Carpal Tunnel are medically different conditions. Sometimes, De Quervain’s syndrome is confused with carpal tunnel syndrome, but De Quervain’s syndrome only affects the tendons of the thumb. Carpal tunnel syndrome is a condition of the nerve instead of the tendon. Read more about carpal tunnel syndrome here and the types of hand surgery we offer at the Harley Clinic.

How Do You Test for De Quervain Syndrome?

To diagnose De Quervain syndrome, your doctor will need to perform a physical examination. They may also perform a test called the Finkelstein test. During the test, you will be asked to form a fist with the fingers covering the thumb. You then bend the wrist slightly towards the pinky finger. If you have pain during this movement, it will help to confirm the condition.

De Quervain's Syndrome Treatment Options

There are both surgical and non-surgical treatment options for De Quervain’s syndrome, depending on the individual case.

A non-surgical approach may include the following:

Splint for De Quervain syndrome to immobilise the hand
Avoiding activities that increase swelling
Anti-inflammatory medication
Steroid injections to reduce swelling
Applying ice to the area to help with swelling
De Quervain syndrome exercises

In mild cases, the condition may improve in a few weeks without surgery. However, depending on your response to non-surgical treatments and the severity of the case, your doctor may recommend surgery.

What Happens During De Quervain's Syndrome Surgery?

The procedure itself should take about 30 minutes. Surgery for De Quervain’s disease involves cutting the inflamed area of the tendon sheath. This helps to relieve the pressure that’s on the tendons and improve the movement of the wrist.

Essentially, the aim of the surgery is to widen the tunnel that the tendons glide through and release pressure and pain. It’s also known as surgical decompression of the tendon tunnel.

Your doctor will use either local or, in rare cases, general anaesthetic, depending on the individual. Once the area is numbed, they will then make a small incision around the base of the thumb. Your doctor will identify and protect the nerves that live nearby. Next, they release the sheath methodically, allowing your tendons to move more freely. The incision is then closed, and a bandage will be applied. In some cases, your doctor will apply a splint too.

Then, when the tendon tunnel heals, it’s wider so that the tendons have more room to move around without pain.

How Long is De Quervain Syndrome Surgery Recovery?

Typically, patients feel an improvement in pain and other symptoms soon after the surgery, but most have pain-free movement in about 6 to 12 weeks. The scar may be sore and raised for several weeks.

You should be able to go home the same day as your surgery. You will normally have to wear a big bandage and need to keep your hand elevated for a few days. In general, you will need to stay off work for one week.

During your recovery, your doctor may recommend the following:

Keeping the hand immobile for 2 to 3 days
Applying ice to the area every couple of hours for the first 3 days
Avoiding activities that could put pressure or strain the site for the first 2 weeks (lifting, cooking, typing etc.)
Take pain medications as directed by your doctor
Keep the incision site clean and dry for 1 to 2 weeks until your doctor removes any stitches

After the initial recovery phase, you may need to perform some physical therapy to strengthen the hand and fingers. Your surgeon will be able to advise on this timeline.

What are the Potential Risks and Complications of De Quervain Syndrome Surgery?

De Quervain’s syndrome surgery is a minor surgery and generally very safe. But like any surgery, there are some risks and potential complications.

As the procedure involves gently moving the nerve branches, you may experience temporary numbness on the back of the hand or thumb.

Other potential risks, complications, and side effects include:

Infection
Swelling
Damage to nerves
Displacement of tendons
Bruising
Wound healing problems

Hand Surgery Consultation at Our Harley Street Cosmetic Surgery Clinic

Before any surgery at the Harley Clinic, you will need to come for a cosmetic surgery consultation. During this time, you can ask plenty of questions, and your doctor will explain everything to you. They will advise you on how to prepare for your surgery and may ask you to stop taking certain medications and avoid eating and drinking for a certain time before the surgery.

De Quervain’s Syndrome UK: Why Come to the Harley Clinic for Hand Surgery

If you’re experiencing thumb pain or have stopped responding to non-surgical De Quervain syndrome treatments, book a consultation today at the Harley Clinic. We can talk through your options and create a personalised treatment plan.

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