De-Quervain's Tenosynovectomy
The Condition
The cause of pain at the base of your thumb / wrist is due to thickening of the lining that tendons run through. All tendons run through a lubricated lining, and if the tendon lining becomes thickened, then, instead of the tendon gliding smoothly, it rubs and causes inflammation, which causes pain and tenderness. A tendon lining which is inflamed is called a tenosynovitis. De Quervain was a French Surgeon who first discovered the condition.
The Operation
The operation releases the tight area of tendon sheath, and allows the tendon to glide freely and comfortably. After the operation the small wound is closed with glue or stitches.
During surgery, after the actual operation is finished, local anaesthetic is put in the wound. This makes your hand numb for 6 – 12 hours and there is only a mild ache when the effect wears off.
You will find that the pain that you had before surgery will go within a matter of 24 hours and you will be quite free to use the hand and thumb fully.
After the Operation
We usually put on a small dressing under the large wool land crepe bandage. You can remove the big bandage yourself the day after the operation, but keep the small dressing on. This will allow you to start using the thumb more freely. You need to keep the small dressing on and the hand dry for 10 days after the operation, whilst the wound is healing.
If we have used stitches, they will be removed ten days after surgery and you need to keep the hand dry until that time. Exercising in warm to hot water after removal of the stitches is useful to regain movement. Use of E45 cream to massage the hand and keep the skin soft is helpful.
Risks of Surgery
- 1. Complications can include irritation of small nerves in the area of the wound. This usually settles week-by-week, and goes by 6 weeks after surgery. Occasionally treatment is required if the sensitivity continues. This occurs in less than 1% of all operations. Occasionally the tendon sheath (the tendon lining) regrows very rapidly and surgery is needed again but this is in less than 0.5% of operations. Because of the delicate nature of this particular operation, it is always done by your Consultant, Mr AW Samuel, and not a junior member of the team.
- 2. Infection can occur – as after any cut in the skin, this occurs in about 1% of all operations.
- 3. Circulation disturbance (sympathetic dystrophy or regional pain syndrome) can occur in approx 1% of all operations. Prompt treatment with medication or injection is usually very effective. You will be reviewed regularly after surgery so this or any other complication, is treated promptly.
Green – Textbook of Hand Surgery
Bulstrode – Textbook of Orthopaedic Surgery
Internet sites:
www.mayoclinic.com www.orthogate.com