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De Quervain's Tenosynovitis

Inflammation of thumb tendons at the wrist

What is De Quervain's tenosynovitis?

It is part of tendinitis around the wrist and involves 2 tendons destined for the thumb. These tendons pass in direct contact with the bone (radius), and are anatomically held firmly by the extensor retinaculum, a kind of thick and wide ligament, acting like a belt for the tendons.

Like many tendinitis, this disease is often the consequence of a recent increase in hand solicitation (gardening, DIY, repetitive professional or domestic maneuvers, change of work station...) or poor posture during unusual movements (sport, bodybuilding, musical instrument...).

The arrival of a child is a frequent factor (hormones + breastfeeding/rocking position, use of stroller accessories, car seat etc.)

How does De Quervain's tenosynovitis usually present?

During repeated sliding of tendons against the ligament, inflammation occurs and causes pain on movement, on palpation of the region and sometimes swelling of the region.

Traction on the tendons during clinical examination and the gestural context allow diagnosis.

Imaging examinations

An imaging examination is sometimes requested by your doctor or surgeon when the clinical picture is less clear, but it is not necessary, as the diagnosis is clinical. Ultrasound is often negative in chronic forms of the disease, where inflammation is no longer as intense and exudative.

I have De Quervain's tenosynovitis, what can be done?

At the beginning, the condition is acute and can be quickly corrected if the causal activity is interrupted. When the disease sets in, it becomes chronic and its treatment is longer and more difficult.

Conservative treatment

  • Rest splint placed at night to relax the tendons
  • Physiotherapy sessions (often ineffective - and not systematically recommended)
  • Corticosteroid infiltration (can sometimes accelerate recovery, but does not always have complete and permanent effectiveness, especially when tendinitis has been present for several months)

⚠️ Modification of gestures - ESSENTIAL

Modification of the gestures responsible for tendinitis is ESSENTIAL to hope for healing, and especially the absence of disease recurrence.

This involves limiting painful activities for the time necessary for complete recovery, then supervision by a professional when resuming the causal activity (sport, music, work station...) to correct poor postures.

Surgical treatment

When the disease resists this medical treatment, or has been present for many months, surgery is required.

It consists of sectioning the retinacular ligament to leave more space for the tendons and eliminate the conflict. The surgeon also removes the inflammatory synovitis sometimes surrounding the tendons, responsible for part of the pain.

I'm going to have De Quervain's tenosynovitis surgery... what will happen to me?

It is a routine procedure of short duration, most often performed under regional anesthesia, in outpatient hospitalization.

Healing

Two weeks of healing are necessary, with a small dressing. For 1 month, it is not recommended to carry loads, to reduce the risk of tendinitis recurrence.

Post-operative splint

A splint is sometimes recommended to rest the wrist after the procedure, in the first 2 weeks to reduce anterior dislocation of tendons, and guide retinaculum healing.

Recovery

Pain disappearance is often rapid, but the existence of an old chronic condition can slow healing.

Obviously, modification of the gestures responsible for tendinitis is ESSENTIAL to hope for healing, and especially the absence of disease recurrence.

Is De Quervain's tenosynovitis surgery risk-free?

No, of course not. Although it is a codified, routine and mastered procedure, the risk exists, as with any surgery, even if complications are rare.

We mainly find, even if all precautions are taken:

  • Healing difficulties
  • Hematoma
  • Local infection
  • Algodystrophy
  • Anesthetic complications
  • Section of a very fine branch of the radial nerve
  • Scar hypersensitivity
  • Anterior instability of tendons when retinaculum healing is too loose

What is the risk of not having surgery?

The risk is the continuation of the disease and pain with increasing discomfort for increasingly light activities.

With chronification of tendinitis, recovery is more difficult and sometimes incomplete.

Do you suffer from De Quervain's tenosynovitis?

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