DEQUERVAIN'S TENOSYNOVITIS

• General Information
• Symptoms
• Occupational Causes
• Ergonomics
• Early Treatment (pre-surgical healing)
• Surgical Procedure
• What should I do after surgery?
• Post-Surgical Therapy
• What should I expect after surgery?

GENERAL INFORMATION

• An inflammation of the tendon or tendon sheath at the base of the thumb where it connects to the wrist
• The tendons that pull the thumb away from the fingers (the "hitch-hiking" position) become inflamed and irritated as they pass beneath a ligament that holds the tendons to the bone

SYMPTOMS

• Pain at the base of the thumb which may radiate up the forearm or down the thumb
• Swelling at the base of the thumb
• Pain increases with wringing motions of the wrist, unscrewing a jar lid, opening a car door, turning a key, or buttoning a shirt
• Pain increases with pinch, grasping, or other thumb movements
• Pain increases with pouring type motions when the wrist is pulled down towards the small finger side of the hand
• Clumsiness and dropping objects when pain causes grip to be insecure

OCCUPATIONAL CAUSES

• Activities requiring wringing motion
• Repetitive activities that move the wrist in the direction of the small finger, especially with grip (for example, pouring from a pitcher using a hammer) or if the thumb is held in the palm of the hand (using a buffing or grinding machine)
• When the thumb is held rigidly in the hitch-hiking position (for example, when held tensely off the keyboard while typing)

ERGONOMICS

• Use the power grip (for example, holding an object with all the fingers in a loose grip) versus using a pinch
• Use the shoulder to provide movement instead of using isolated wrist movements  (for example, while fastening nuts and bolts or when holding the computer mouse)
• Use the appropriate tool for the job
• Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool)
• Use power tools when possible
• Use tools that provide leverage; Work in the mid-range of motion; Don't move the wrist through it's motion extremes
• Work with the wrist in a neutral position
• Use ergonomically designed tools with modified handles that help maintain the wrist in a neutral position if they are available
• Avoid holding the thumb in the palm of the hand while bending the wrist towards the palm or towards the small finger side of the hand
• Minimize repetition; Periodically rest the arms briefly during repetitive or stressful activity; Stretch often during repetitive activity
• Slow down the activity
• Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control
• Use the least amount of force necessary during the activity
• Alternate work activities so the hands are not performing any one task repetitively for any length of time
• Use good ergonomic practices at work; Apply these tendon and nerve protection principles to daily and leisure activities as well.
• Practice good health habits

EARLY TREATMENT

• Splinting (custom fit or pre-fabricated) which holds the wrist neutral and the thumb in a relaxed, functional position (a thumb spica splint)
• Avoid the activities which cause pain, especially those requiring pinching and pulling with the thumb; Modify activities which can not be avoided
• An ergonomic consultation to modify work environment stressors
• Use of ergonomic equipment and tools such as split keyboards and hammers with a specially designed handle that holds the wrist neutral
• Education in tendon and nerve protection techniques including modification of sleep and work habits
• Hand therapy techniques to improve circulation, decrease swelling and reduce pain
• A supervised exercise program to stretch tight muscles, strengthen weak muscles, promote postural balance;  the program should include tendon and nerve gliding exercises
• The M.D. may prescribe anti-inflammatory medications such as Naprosyn or ibuprofen;  if these medications cause stomach irritation, the M.D. may also prescribe a stomach calmer such as Zantac
• The M.D. may recommend a cortisone injection near the area of friction at the base of the thumb

SURGICAL PROCEDURE

• A DeQuervain's release is a minor operative procedure that releases the sheaths surrounding the two thumb tendons at the base of the thumb
• A small incision is made on the thumb side of the wrist
• This procedure relieves the pressure and the friction on the tendons

WHAT SHOULD I DO AFTER SURGERY?

• Keep the incision clean and dry
• Change the bandages as needed, especially if saturated with blood
• Keep the fingers moving - make a gentle fist and hook fist, spread the fingers apart
• Begin gently moving the thumb once the M.D. approves movement
• Use your hand for light activity, as normally as possible, but respect pain
• Once the stitches are removed, begin gently massaging the scar
• Use a silicone based scar bandage if the scar is thick, stuck, red or painful
• Gradually increase strength activities at 6 weeks post-surgery

POST-SURGICAL THERAPY

• Cleaning and dressing of the incision until healed
• Scar management including massage, the use of scar molds or silicone gel sheeting, ultrasound, hot packs
• Swelling reduction techniques including instruction in elevation of the arm, compression wraps, retrograde massage, cold packs
• Desensitization techniques if scar is sensitive
• Active motion including tendon and nerve gliding exercises as necessary
• Strengthening and work conditioning activities beginning at 6 weeks after surgery to tolerance

WHAT CAN I EXPECT AFTER SURGERY?

• The pain that travels or radiates up and down the arm is often relieved almost immediately.  Pain becomes more centered around the surgical site while the hand is healing. 
• The surgical area of the wrist will likely be tender for 3-4 months after surgery.
• The scar area may be sensitive for about the same length of time.  
• There will be some amount of swelling over the surgical area for months as well.