De Quervain’s syndrome is a painful ailment, otherwise known as wrist tendon sheath inflammation – it affects the tendons of the long thumb abductor and the short extensor of the thumb. The pain accompanying the disease appears in the patient when the patient abducts and straightens the thumb and tends to radiate to the forearm, making everyday functioning difficult. Activities such as tying a shoe, typing on a computer keyboard, using a mobile phone or brushing your teeth are starting to be associated with severe pain.
Women taking care of children and overloading their wrists and thumbs every day, e.g. when lifting and holding children in their hands, as well as during household chores, such as ironing or cutting food, are particularly exposed to the disease. For this reason, it is commonly referred to as “mother’s thumb”.
Symptoms accompanying the inflammation of the tendon sheaths are primarily pain in the thumb that increases with specific movements. Reddening of the skin on the thumb and the radial side of the wrist is also common.
The long-lasting inflammatory process leads to permanent tension of tendons and fibers and thickening of the sheaths. As a result of this process, the amount of lubricant produced inside them decreases, which results in difficulty in the movement of the tendons and the aforementioned pain. Sheaths react with swelling, exudation and hyperemia. As a result of this process, there is a fibrosis and thickening of their walls and a narrowing of the lumen.
De Quervain’s syndrome is a disease of an unknown etiology. However, it is known that they can be caused by overload and repeated movements that strain the joint. Therefore, people who perform manual professions on a daily basis – e.g. pianists, carpenters, are exposed to them. Monotonous activities are also conducive to him – such as typing on a computer or telephone keyboard, which leads to tension between the tendons, the tendon sheath and other tissues of the hand. It can also be the result of a wrist injury or RA (rheumatoid arthritis), which results in the formation of inflammatory adhesions.
Treatment of this ailment is primarily based on diagnosis, which is facilitated by the so-called von Finkelstein test. This is a simple way to diagnose de Quervain’s syndrome by bending your thumb and folding the rest of your fingers over it, then tilting your entire hand outwards towards the elbow. At this point, the patient develops severe pain, suggesting the occurrence of this condition – while in case of any doubts, the doctor will refer the patient to an additional ultrasound examination.
Treatment initially is usually based on conservative therapy using pharmacological agents and rehabilitation (e.g. kinesiotaping, manual therapy, cryotherapy). Pain relief and anti-inflammatory injections with corticosteroids blocking the progression of inflammation can also be helpful. It is also advisable to limit the use of your hands. Especially refraining from grasping heavy objects and not clenching your fists. The doctor may also advise you to immobilize your hand with a dressing and leave it on until the inflammatory symptoms in the sheath are gone.
If there is no improvement, it is necessary to implement surgery. The procedure is performed as part of the so-called one-day surgery. It consists in putting a pressure band on the hand, causing hand ischemia, and then incision or excision of the tendon sheath and possible adhesions and release of the tendons. The patient returns home on the same day with a soft dressing – and then requires a medical check-up and removal of stitches at the time indicated by a specialist (usually up to about two weeks).
The patient must be prepared to feel pain in the entire hand and numbness of the fingers after the procedure. If the pain is too strong, use cool compresses to reduce swelling and apply to the remaining indications of a doctor who may recommend holding the operated hand highly and exercising the thumb.
We cordially invite you to consultations and treatments that are carried out in our clinic as part of one-day surgery, an excellent specialist – Dr. Paweł Zejler, hand surgeon. The doctor is one of the best specialists in Europe (FESSH European diploma), has many years of professional and internship experience in leading microsurgery and hand surgery centers in the world (including Taiwan, USA). Contact and registration: 18 264 40 00