De Quervain's Disease (tenosynovitis)
Inflammation of the tendons on the side of the wrist causes pain; this is called De Quervain's disease or tenosynovitis. The tendons that become inflamed are the ones that lift the thumb away from the hand. This problem is common in mothers with new babies and is due to lifting the baby in and out of the cot. De Quervain's disease may also occur in other patients after doing a lot of lifting or repetitive activity using the hand, for example painting or gardening.
The diagnosis of De Quervain's disease is usually made from the history and examination alone. Occasionally an ultrasound scan is necessary to confirm the diagnosis.
Mild cases of De Quervain's disease may settle with resting the wrist and thumb in a splint and using anti-inflammatory painkillers such as ibuprofen. The treatment in most cases is a steroid injection, performed in the clinic, which is usually effective in my patients. I perform the injection very gently using a tiny needle and local anaesthetic to ensure that it is as comfortable as possible. Steroid injections do not have an immediate effect and typically take about 10 days to work.
The alternative to steroid injection is surgical release of the affected tendons; surgery is also indicated in cases that do not resolve following steroid injection.
Surgery is usually performed under local anaesthetic and takes about 20 minutes to do. A 2-3cm incision is made on the side of the wrist and the tight fibrous layer covering the tendons is divided. As a Plastic Surgeon, I will ensure the best possible scar is achieved. A light dressing is applied. Hand therapy is started a few days after surgery to ensure a swift recovery and return to using the hand normally.