De Quervain's Disease Release

De Quervain's tenosynovitis, commonly referred to as "mommy's thumb," is a condition characterized by inflammation and pain in the tissues surrounding the wrist and hand. It primarily occurs in women during late pregnancy or shortly after childbirth but can also affect individuals outside of this demographic.

 

Symptoms

The primary symptoms of De Quervain's tenosynovitis include:

 

• Pain and swelling in the wrist and hand
• Numbness and tingling sensations that may radiate to the fingers, forearm, and shoulder
• Limited hand function, which may manifest as decreased grip strength and difficulty performing fine motor tasks
• Etiology

The exact cause of De Quervain's tenosynovitis remains unclear, but it is believed to be associated with multiple factors, including hormonal changes, ligament laxity, edema, and inflammation of the hand tissues. Hormonal fluctuations during pregnancy may adversely affect hand tissues, leading to pain and discomfort.

 

Typically, symptoms may resolve on their own within a few months postpartum; however, in some cases, treatment and rehabilitation may be necessary to alleviate symptoms and promote recovery. Treatment options include rest, physical therapy, pharmacological interventions, and the use of supportive devices.

 

Risk Factors

Several risk factors have been identified for De Quervain's tenosynovitis:

 

• Pregnancy: The condition is most commonly observed in women during late pregnancy or shortly after childbirth, with an estimated prevalence of 2% to 3% among pregnant women.
• Multiple Gestation: Women carrying multiple fetuses are at a higher risk for developing De Quervain's tenosynovitis due to increased stress and strain on the hands and wrists.
• Excessive Weight Gain: Rapid or excessive weight gain during pregnancy can contribute to increased load on the hands and wrists, leading to inflammation and pain.
• Personal and Family History: Research suggests that women with a family history of De Quervain's tenosynovitis may be more susceptible to the condition. Additionally, women who have previously experienced De Quervain's tenosynovitis are at a higher risk of recurrence during subsequent pregnancies.
• Age: While De Quervain's tenosynovitis can occur at any age, older women may be more prone to developing the condition compared to younger women.
• Comorbid Health Conditions: Certain health issues, such as hypertension, diabetes, and thyroid disorders, may increase the risk of De Quervain's tenosynovitis.

 

Medical Evaluation and Diagnosis

 

Diagnostic Procedures

• Medical History: The physician will inquire about the patient's symptoms and medical history, including the severity and duration of pain, and any factors that exacerbate or alleviate the discomfort.
• Hand Function Assessment: A physical examination of the hand may be conducted to observe swelling, redness, and temperature changes in the wrist, fingers, and forearm. The physician may also assess hand function, including grip strength, finger dexterity, and coordination.
• Neurological Examination: In some cases, a neurological assessment may be performed to evaluate the function and responsiveness of the hand's nerves.

 

​​​​​​​Surgical Treatment for De Quervain's Tenosynovitis

Surgical intervention is considered when non-surgical treatments fail to relieve symptoms or in cases of severe conditions. Common surgical options include:

 

De Quervain's Release Surgery: This is one of the most frequently performed surgical procedures for De Quervain's tenosynovitis. The surgery aims to relieve pressure within the wrist canal to alleviate compression on the affected tendons. During the procedure, the surgeon makes an incision in the wrist to remove the constricting tissue surrounding the affected tendons.

 

Preparation

• Fasting Instructions: Patients are generally required to fast for 6 hours before surgery, meaning no food intake for 6 hours prior to the procedure. A small amount of plain water is allowed until 2 hours before the surgery.

• Preoperative Medications: Take any prescribed medications as instructed. If you are currently taking medications that affect blood clotting, such as Aspirin, Warfarin, Xarelto, Pradaxa, or herbal medicines, please inform your doctor as soon as possible.

• The doctor will explain the reasons for the procedure, the process involved, and any potential complications. After understanding this information, the patient can sign the consent form.

 

Wound Care

• Keep the wound dry and clean, and follow the instructions provided by the doctor and nurse for wound care.
• The stitches may need to be removed within two weeks or may dissolve on their own.
• Follow the doctor's instructions for taking medications.
• If the patient’s job requires heavy lifting or strenuous activities, it may be necessary to take time off work and rest for several weeks.
• The wound will be protected with waterproof dressings; do not remove the dressings yourself, and keep them dry and clean.
• If there is significant bleeding, persistent redness and swelling, purulent discharge, or severe pain after surgery, seek medical attention promptly.
• Physical therapy and rehabilitation exercises are recommended to restore hand function and strength. Follow the physical therapist's guidance for exercises and adhere to the rehabilitation plan.

Follow-up and Recovery

• Ice the affected area as needed.
• Temporarily avoid twisting and shaking activities.
• Ensure adequate rest and wear protective gear.
• Avoid prolonged or repetitive use of the thumb.

 

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Reference

Mayo Clinic. Diseases Condition. Available at: https://www.mayoclinic.org/diseases-conditions/de-quervain-tenosynovitis/symptoms-causes/syc-20371332

 

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