De Quervain’s Disease
De Quervain’s Disease is a common disease of a tendon in the wrist. The tendon affected is located on the thumb side of the wrist and can cause pain when moving the wrist or thumb in certain directions. The direction of wrist movement is the movement of the wrist from the thumb side to the little finger side. The thumb will hurt when it is moved upwards (hitchhikers position) to a flexed position. The test physicians use to help with the diagnosis is called the Finklestein Test. This is done by placing the thumb into a closed fist and moving the wrist from the thumb side to the little finger side. This test pulls the tendons which travel through the tendon sheath involved with de Quervain’s Disease of the Tendon Sheaths.
There are mild, moderate, and severe forms of de Quervain’s Disease. The mild form is usually treated with occupational therapy splinting, or steroid injections. The moderate or severe forms are treated with surgery to release the tendon sheath through which the involved tendon travel. If the steroid injections work, then no surgery is required. If not, surgical release is required.
De Quervain’s Disease of the Tendon Sheath is the result of inflammation caused by the tendon passing tightly within the tendon sheath for a long time. As the inflammation worsens, the symptoms worsen. Steroid injections are used to control the inflammation. It is the gold standard for controlling inflammation. There are non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen (Motrin or Advil), naprosyn (Aleve), and acetaminophen (Tylenol) which can benefit a patient with mild de Quervain’s Disease.
When surgery is determined to be the best treatment plan for de Quervain’s Disease, then the operating room is schedule. The procedure to release the tendon sheath is done safely in an operating room. The procedure requires a small amount of time to do and the post-operative course is usually uneventful. Patients are not required to wear splints postoperatively and sutures are removed in 1-2 weeks. It is expected that the pain associated with de Quervain’s Disease will be gone after release of the tendon sheath.