DEFINITION & ANATOMY:
DeQuervain’s (deh-kwer-vanes) tendinitis refers to inflammation of two tendons on the side of the wrist near the thumb. (Fritz DeQuervain was a 19th Century Swiss surgeon who first described the condition.) There are two tendons which travel through a narrow tunnel on their way to the thumb. These tendons may become inflamed making movement of the thumb painful. The pain typically goes up and down the side of the thumb and past the wrist up the forearm following the path of the tendons. The inflammation may have
been started by “doing too much” on one particular day or from repetitive overuse and doing too much too often. For example, pain may have gradually begun with repeated use of a computer mouse. Pain may also begin after a relatively minor injury such as a thumb sprain while skiing. Sometimes people report they have recently had a child and get this condition from repeatedly picking up the infant. Xrays may be required to differentiate this inflammatory condition from arthritis at the base of the thumb.
Treatment is initially aimed at reducing the inflammation around the tendons. This may require splinting and anti-inflammatory medication. Therapy is often effective in reducing inflammation. This may involve treatment such as ultrasound as well as changing one’s computer setup. If pain persists, an injection of steroid may be required. Approximately 50% of people respond to a single injection. If relief is incomplete or recurs, a second injection may be tried again. For the small percentage of people not responding to two injections and splinting, surgery may be needed to relieve the discomfort. One occasional risk of steroid injections is skin color changes that peak at 6 weeks after the injection and usually will improve over time.
Surgery involves opening the roof of the tunnel which holds the tendons. This gives the tendons room to glide relieving both the pain and allowing the inflammation to subside. Surgery is done as an out-patient procedure under local anesthesia. A splint is worn for one to two weeks after surgery which restricts wrist motion but leaves the fingers free for daily activities.