De Quervain Syndrome
De Quervain tenosynovitis is the inflammation of the tendon sheath covering the abductor pollicis longus and the extensor pollicis brevis tendons. These two tendons (pollicis brevis and the abductor pollicis longus) are vital in controlling the movement of the thumb. The De Quervain Syndrome has multiple other names, including mommy thumb, mommy’s wrist, gamer’s thumb, washerwoman’s sprain, designer’s thumb, and texting thumb.
As the non-scientific nicknames suggest, this is a condition that is usually caused by repetitive movement of the thumb over a prolonged period. But, of course, this does not rule out other causes such as rheumatic diseases like multiple forms of arthritis or gout. In addition, the pain resulting from having a mommy’s thumb can keep escalating to the point of affecting the entire arm.
Diagnosis and Treatment
De Quervain Syndrome patients commonly complain of pain and/or swelling between the base of the thumb and the wrist, trouble when performing tasks requiring twisting hand motions. Therefore, at the examination in our plastic surgery UK clinic, the doctor will conduct a pain assessment by conducting a Finkelstein test, the most-effective way of testing for De Quervain’s tenosynovitis.
The Finkelstein test is performed progressively by first having the patient gently suspend their affected arm off the edge of a table and evaluating the pain level, if any. If there is no pain, the next step would be to apply some gentle force to the hand while it’s still in the suspended position while listening to the patient’s feedback on the pain. The more advanced and original version is where the patient is asked to flex their thumb towards the inner palm and flex the rest of the fingers over it. The wrist is then bent in the direction of the little finger. If the patient reports pain in the thumb joint right next to the wrist, they probably have De Quervain’s tenosynovitis.
In cases where the pain is chronic, anti-inflammatory medications, ice or heat, corticosteroid injections, splinting the wrist and thumb for at least four weeks, rest, and some exercises may be recommended. These solutions may stop or improve the condition’s progression or just manage it depending on the patient. If medications and therapeutic methods don’t work on the pain, surgery is a more permanent alternative.
De Quervain Syndrome Surgery and Recovery
At our plastic surgery clinic, the De Quervain Syndrome surgery is performed on an outpatient basis under local anaesthesia, and it takes only about 60 to 90 minutes. First, a small cut is made at the base of the thumb, and the scalpel is used to carefully manoeuvre past blood vessels and nerve branches, exposing the tendon path.
The surgeon then cuts through the swollen tendon sheaths to release the tension causing the pain. Next, the area is examined to ensure that there is no build-up of scar tissue due to the friction in the joints or other parts of the tendons with inflamed sheaths. The patient will then be asked to move their wrist to ascertain movement, after which the wound is cleaned and closed with sutures.
After the corrective procedure, the wound is dressed, and the patient can be released with post-operative instructions. The immediate outcome may be some numbness at the surgical site, which should go away after a few weeks. A splint will be placed to hold the thumb in place so that the thumb doesn’t get inflamed from further movement. After recovery, some physiotherapy can be proposed for effective healing.