Surgery for De Quervain’s Disease

Introduction

There are two tendons which control the thumbs movements. These tendons glide in a small tunnel or sheath which is lined by smooth tissue layer called synovium. Inflammation of the synovium affects the ability of the thumb to move freely and is the cause of de Quervain's tenosynovitis. This condition is named after a Swiss surgeon who first identified the condition.

Symptoms and signs of de Quervain’s tenosynovitis include:

  • Pain and tenderness at the base of the thumb and wrist near the thumb.
  • Swelling to the wrist near the thumb.
  • Pain may occur gradually or suddenly and can radiate up the arm.
  • Pain aggravated by thumb movement.
  • Difficulty gripping objects.
  • Impaired thumb movements affecting daily activities.

Indications for surgery

The diagnosis of de Quervain’s tenosynovitis is suggested by clinical history and examination. A simple test called the “Finkelstein Test” will confirm the diagnosis. Dr Lane will ask you to make a fist with your fingers closed over the thumb with the wrist angled towards the little finger. In de Quervain’s tenosynovitis, this manoeuvre is painful over the thumb side of the wrist.

Dr Lane may suggest conservative non-operative treatments initially which include:

  • Non-steroidal anti-inflammatory drugs such as Brufen, Naprosyn or Celebrex.
  • Steroid injections.
  • Splinting.

If these conservative options fail and the condition impacts daily activity, surgery is indicated.

Pre-operative Instructions

Once surgery is decided, Dr Lane will discuss the procedure with you. Information leaflets covering the condition and proposed surgery, surgical risks and after-care are provided.
Anti-inflammatory drugs such as Feldene, Naprosyn, Brufen, Ibuprofen, Indocid, Voltaren, Mobic and Celebrex should be stopped 5 days prior to surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug use prior to the theatre should be discussed with Dr Lane as this would depend on the patient’s underlying medical condition. The wrist to be operated on should be free of abrasions, cuts or sores as this would increase the risk of infection. If there is damaged to the area that has to be operated on, then it is likely that the operation will be postponed until the skin is healed.

De Quervain’s surgery is performed as a day procedure. You will be given clear instructions by the reception staff when to attend the hospital depending on your surgery time. Please take your Medicare, DVA or Private Health Care cards to the day Hospital Admissions Unit. You are advised not to eat or drink anything 6 hours prior to surgery.

Prior to surgery:

  • You will be admitted by the duty nurse and baseline observations taken.
  • Theatre gown given to wear.
  • The hand and wrist will be inspected, washed with anti-septic solution and covered with a sterile drape.
  • You will be given TED stocking to wear on your legs to reduce the risk of deep venous thrombosis.

The nursing staff will take you into the theatre complex and then into the anaesthetic bay next to the operating room. There you will meet your anaesthetist and Dr Lane.

De Quervain’s surgery is usually performed under local anaesthetic with twilight sedation or under a general anaesthetic.

Procedure

Once in the operating room, a tourniquet is applied to the upper arm to give the surgeon a bloodless field for surgery. The hand and arm up to the tourniquet is prepped with anti-septic solution. Sterile drapes then cover the patient with a window for the operating site.

A small incision is made over the affected tendons in the wrist area. Dr Lane will then cut the sheath that holds the tendons giving them more room to move. The incision is then closed with sutures. Local anaesthetic is injected around the site to aid post-operative pain relief. The wound is covered with primapore and then further sterile dressing and crepe bandage applied.

After surgery, you will be taken to the recovery room. When you are adequately awake, observation stable and able to eat and drink you will be ready for discharge home. The anaesthetist may give you a script for pain relief medication. It is important that you have someone to take you home.

Post-operative instructions

 After surgery, Dr Lane will give you guidelines to follow:

  • Keep outer dressings clean and dry for 3 days and then they can be removed leaving the primapore intact.
  • Keep primapore clean and dry until seen in Dr Lane’s rooms at 12 to 14 days after surgery. At this time your sutures will be removed and if all looks well, Dr Lane will advise you to move the wrist freely as comfort allows.

Risks

General risks associated with Anaesthetic (v. rare)

  • Death.
  • Myocardial Infarction.
  • Stroke.
  • Deep venous thrombosis.

Local risks (uncommon)

  • Infection.
  • Bleeding including injury to the arteries of the finger and hands.
  • Nerve Injury – causing weakness, paralysis or loss of feeling to the hand area.
  • Incomplete release of sheath.

Patients who are smokers, diabetic or have multiple pre-existing medical conditions are at a higher risk of adverse complications.