De Quervain's Tenosynovitis

What is De Quervain's tenosynovitis or washerwoman’s sprain?
De Quervain's tenosynovitis is an inflammation of the sheath surrounding the tendons and the tendons themselves, which moves the thumb on the side of the wrist and at the base of the thumb. It can be brought on by a simple strain injury or repeated stresses of the tendons of the thumb. It causes pain on movement, especially turning a key, wringing out clothes or any movement which puts strain on the thumb. Occasionally a painful swelling in the area is seen and felt.

How is De Quervain's tenosynovitis diagnosed?
De Quervain's tenosynovitis is diagnosed based on the typical appearance, location of the pain, and tenderness in certain hand positions. There are many other problems which can cause pain in this area and an accurate diagnosis by a specialist hand surgeon is therefore paramount for the correct treatment.

How is De Quervain's tenosynovitis treated?
In the first instance it is treated with rest in a special custom made splint. Off the shelf splints are not enough and may end up doing more harm than good. Regular analgesia in the form of NSAIDs (Non Steroid Anti Inflammatory Drugs), such as Voltarol or Ibuprofen is very beneficial. Because the pathology of this condition is inflammation it takes a minimum of 6 weeks before a conservative treatment plan is effective. Some cases do not respond to conservative treatment and surgery is advised. This is performed as a Day Case under General Anaesthesia. The sheath surrounding the tendons is opened through a very small skin incision, allowing the tendons to run freely. You will have to wear a splint following the operation as well, but only for two weeks.
Early diagnosis and treatment is paramount.

The possible complications of this surgery are:
Infection (very rare)
A bleed under the skin
Wound dehiscence (wound comes apart, this will be treated with dressings until the wound is healed)
Painful scar
Altered sensation over the back of the index finger and thumb (usually temporary)
Complex Regional Pain Syndrome (pain disproportionate with the procedure, needs urgent attention) – very very rare

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