What is DeQuervain’s Tenosynovitis?
Tendons are strong, cordlike fibers that attach muscle to bone across a joint. Two tendons used to straighten or extend the thumb to the hand are called the abductor pollicis longus (APL) and the extensor pollicusbrevis (EPB) (Figure 1). These tendons run in a tunnel, called a retinaculum, along the radial (or thumb) side of the wrist. The retinaculum is lined with tenosynovium, a slippery substance allowing tendons to glide back and forth without friction. Inflammation of the tenosynovium is called tenosynovitis, and the associated swelling can hamper the gliding action of the tendons. DeQuervain’s tenosynovitis affects the tendons on the thumb side of the wrist, and repetitive motions such as grasping, pinching, squeezing or twisting may be the cause this inflammation.
Signs and Symptoms:
Similar to arthritis, DeQuervain’s tenosynovitis causes pain, aching, or swelling along the base of the thumb (Figure 2). Pinching, grasping or twisting of the wrist may be especially painful. The pain may travel up the forearm toward the elbow, and there may also be a “knot” on the base of the thumb. The thumb may “catch” when it is bent, similar to trigger thumb.
Conservative or non-surgical treatment for DeQuervain’s tenosynovitis may include restricting activities that aggravate the tendon of the thumb, wearing a supportive splint, anti-inflammatory medications, icing the area, and steroid injections to reduce inflammation (Figure 3).
If conservative treatment fails, surgery may be recommended. A small incision is made above the retinaculum. The top of this tunnel is then split so to allow more room for tendons to glide back and forth (Figure 4). Scar tissue forms between the split ends to repair the tunnel, thereby enlarging the space in which the tendons must move. A bulky dressing and splint will be placed after surgery for about 10 days while the tissues heal. Restriction of heavier activities may be necessary for 4 to 6 weeks following surgery.
Dr. McNamara’s Post Op Protocol:
Note: These instructions are to serve as guidelines and are subject to Physician discretion. Actual progress may be faster or slower depending on the individual.