What is De Quervain?
De Quervain or "Morbus de Quervain" is an inflammation of the tendons and/or tendon sheath(s) of the tendons running down the thumb side of the wrist toward the thumb. At the level of the wrist, the tendons run through a tunnel (the tendon sheath) to keep the tendons near the bone. By making repetitive movements with the thumb, the tendons and the mucous membrane around the tendons can swell and inflame, causing friction in the tendon sheath. This causes pain, swelling sometimes reduced mobility of the thumb.
De Quervain is relatively more common in pregnant women, people with diabetes and people with rheumatoid arthritis.
What are the symptoms of morbus De Quervain?
Irritation of the tendons and tendon sheaths causes swelling and pain on the thumb side of the wrist. A palpable thickening over the tendon sheath may also be present. Sometimes the pain radiates to the back of the hand or to the forearm. Certain movements of the thumb and wrist can make the symptoms worse, such as moving the thumb and wrist to the side, grasping objects and making a fist.
Diagnosis
The diagnosis is made based on pattern of symptoms and physical examination. Usually, no additional examination is necessary. An ultrasound may provide additional information. An X-ray is occasionally done to rule out wear and tear of the wrist or thumb base.
Once a diagnosis is made, a treatment plan is developed depending on the severity of the symptoms, the patient's wishes and the patient's overall health.
Treatment:
Non-operative (conservative) treatment
The goal of the treatment is to regain the tendons' composure, thus eliminating the pain symptoms. If activities or movements are clearly provoking, it is advised to avoid them and to rest the wrist and thumb. Adaptations to the pattern of activities and movements are recommended. Sometimes a hand therapist can provide guidance in this regard. Wearing a brace (splint) during strenuous activities, or just during the night can offer additional rest and reduce symptoms. The (temporary) use of anti-inflammatory medication, if the overall health of the patient allows it, can also reduce the symptoms.
If the above therapy does not help sufficiently, an injection of corticosteroids may be considered.
Surgical treatment
If conservative treatment does not help sufficiently, then surgical treatment may be chosen.
The surgery is done in day surgery. A local anesthetic is given in the surgical area on the thumb side of the wrist. The top of the tendon sheath(s) is opened to give the tendons adequate space again. The tendons remain in the same place. If severe irritation is present, the mucosa of the tendons is cleaned.
The wound is sutured with stitches that can be removed after 10-14 days. After surgery, you will have a pressure bandage for several days. In the first weeks after surgery you should take it easy on your wrist to allow the operated tendon sheath to heal. During the consultation hour, you will be given detailed information about post-surgery treatment and recovery, as well as an information brochure about the surgery.
