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Painful tenosynovitis (De Quervain's disease) Print E-mail

Basic information

The Painful tenosynovitis is a painful inflammation of specific tendons which extend the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain that may extend from the forearm (the part from the elbow to the wrist) to the base of the thumb. The painful tenosynovitis was named 'disease De Quervain' by the Swiss surgeon who was the first who described the situation in 1885. This is about one of the most common types of tendon inflammation, endothelial dysfunction (also called inflammation of the tendon sheath).

What causes painful tenosynovitis?

Too frequent, continuous use, a direct trauma or injury to the thumb, repeated grasping and specific conditions of inflammation such as rheumatoid arthritis, can cause the disease. Gardening, rackets and various tasks at work are activities that may worsen the situation. Also this is something that occurs during the last trimester of pregnancy and in nursing mothers. Often the cause is unknown. The painful tenosynovitis affects women during 8 to 10 times more than men. People engaged in activities that require wrist movement sideways and simultaneous grasp with the thumb (such as hitting with a hammer, skiing) are at greater risk of suffering from the disease.

Pain in the back of the thumb, just above the two tendons of the thumb – extensor pollicis brevis and extensor pollicis longus - is indicative of painful tenosynovitis. This situation can occur gradually or suddenly. In any case, the pain may move into the thumb or the forearm. The movement of the thumb can be difficult and painful, especially when trying to catch or grasp objects. Some people also feel swelling and pain on the side of the wrist at the base of the thumb. The pain may be increased by moving the thumb and wrist. Some people also feel pain on direct pressure in the region.

The test used most frequently for the diagnosis of painful tenosynovitis is the Finkelstein examination. Your doctor will ask you to make a fist with the thumb closed into the palm. When you suddenly bend the wrist from the side of your little finger (as if we throw the rod in fishing), the swollen tendons are pulled through the narrow passage. If this movement is very painful, it is likely you suffer from painful tenosynovitis. Arthritis and other forms of tendonitis can also cause symptoms in the region.

What may be the benefits of the treatment?

The main treatment benefits are to stop the pain associated with the situation and improve mobility and function. Treatment usually involves the patient to wear a splint for the whole day and for four to six weeks to immobilize the area to refrain from activities that may worsen the situation. Ice can also be applied locally to reduce swelling. If symptoms persist, your doctor may give you an anti-inflammatory drug prescription - which can be taken orally or injected - to reduce swelling. If painful tenosynovitis is not responding to treatment then you may need surgery.

What are the risks and complications of surgery?

Risks include damage to the superficial radial nerve, infection, bleeding, thumb stiffness, relapse, pain or numbness on the incision.

How to prepare for surgery?

Always ask the physician for complete instructions on preparing for surgery. Usually our preparation includes:

• Complete pre-operative tests or lab tests set by the treating doctor.
• Arrange for someone to drive you from hospital to home.
• Do not take aspirin or other non-steroidal anti-inflammatory drugs for one week before surgery.
• Contact the telephone center to confirm the place of the surgery and the time of your appointment.
• Do not eat or drink anything after midnight the night before surgery.

Are there any exercises I can start with now, before the surgery?

The movements of the thumb should be up to the point of no pain.

What should I do on the day of surgery?

• If you receive any medication at this time, you can get it the day of surgery with a single sip of water.
• Do not take pills for diabetes or insulin.
• Do not wear jewelry, earrings, makeup, nail polish, hair clips or contact lenses.
• Leave valuables and money at home.
• Wear loose, comfortable clothing.

What happens during surgery?

The surgery for painful tenosynovitis is a procedure done without hospitalization and usually performed under local anesthesia. The tight tendon’s sheath surgical release minimizes the friction that worsens the inflammation, so we restore the ability of the tendon to move smoothly.

During surgery, some individual interventions may occur, such as the removal of inflamed tissue or small cysts.

What happens after surgery?

We close the wound and apply haemostatic bandage. Then the patient will wear a splint to feel more comfortable. The treating doctor will give a prescription for painkillers and a therapy program to strengthen the thumb and wrist so that they may move freely.

The patient should consult his doctor for more details on the operative procedure.

How long does the recovery period last?

The recovery period varies depending on age, general health status of the patient, and by the time during which we had symptoms of the disease. The use of your thumb will be limited at first, but gradually it will be strengthened and the range of motion will be restored in the upcoming weeks.

What is the rehabilitation process after surgery?

The recovery process includes some exercises to prevent stiffness and swelling and to restore gradually the movement of the hand and wrist. Following, the gradual strengthening will slowly improve the hand’s functionality.

How will I manage at home during recovery from surgery?

The patient should wear a splint, while the shower is permitted. It would be wise, though, to consult your doctor for more details.

How often should I arrange the post-operative appointments with my treating doctor?

It would be wise to consult your doctor relatively, as this varies from case to case.