Anatomy/Cause:
Two of the main tendons to the thumb that help extend and bring the thumb away from the hand pass through a tunnel (or tendon sheath) on the thumb side of the wrist. This can sometimes be referred to as tendonitis or tenosynovitis. When these tendon sheaths become inflamed, pain, swelling, and tenderness to the touch can occur just below the thumb. The most common cause of this is overuse, such as working, newborn mothers, or even in athletes.
Diagnosis:
Typically, the diagnosis of De Quervain’s tenosynovitis is made in the office by your provider. Unless you have other concerns, an MRI is usually unnecessary.
Treatment:
Nonsurgical Treatment
- Ice, NSAIDs (like Aleve or Ibuprofen), and rest can reduce inflammation of the tendons.
- Braces, such as a thumb spica brace can be prescribed to wear during activity or sleep
- Steroid injections are the most effective non-operative treatment, and can be performed in the office to reduce swelling and pain in the tendon sheath. Dr. Fleager will not perform more than 3 steroid injections per wrist, as she does not want to injure the tendon.
Surgical Treatment
If your symptoms do not respond to the above non-operative treatments, surgery may be indicated, and Dr. Fleager will perform a tendon sheath release. This is a day surgery that allows you to return home the same day, and can be done awake or under anesthesia. After sugery, you will wear a splint for 4 weeks, to immobilize your wrist and aid in healing. You are allowed to use your fingers, type, and perform self-care immediately post-op, but must limit heavy lifting for 4 weeks. This is typically very effective at permanently relieving your symptoms.
