DeQuervain’s Syndrome/Release

What is it?

DeQuervain’s Syndrome is inflammation of tendons located on the side of the wrist and at the base of the thumb. These tendons include the extensor pollicis brevis and the abductor pollicis longus, which extend the three joints of the thumb.

In order to properly diagnose DeQuervain’s syndrome your doctor will perform a Finkelstein test.

What are the treatment options?

Treatment will be aimed at reducing inflammation and preserving movement in the thumb as well as preventing a reoccurrence. If treatment is started early on, symptoms should improve in about four to six weeks. If Dequervain’s syndrome began during pregnancy, symptoms will likely end around the end of either pregnancy or breast-feeding.

Over the counter pain medications may be recommended to reduce pain and swelling. If severe enough your doctor may also recommend corticosteroid injections into the tendon and relief is usually found after just one injection.

Things you can do to decrease pain include:

Avoid bending thumb into palm, in combination with deviating the wrist toward the little finger.
Avoid bending thumb into palm, in combination with bending the wrist forward.
When possible, use power grip (fisted grip) position instead of using thumb.
Use tip pinch (thumb and tip of index finger) instead of lateral pinch (thumb and side of index finger)
Avoid/reduce repetitive wrist side-to-side movement, or sustained holding of wrist toward the little finger. Try to work with the wrist in a neutral position and use more of the forearm to complete the task.
Apply ice

You may also see an occupational therapist who will provide instructions on how to relieve stress in the wrist. They will also teach you exercises that will strengthen the muscles in the hand, wrist and arm which will reduce pain and limit tendon irritation.

If all else fails, your doctor may recommend outpatient surgery. The procedure involves inspecting the sheath surrounding the irritated tendons and then opening the sheath to relieve pressure and allow the tendons to glide freely.

Procedure Goals

The goal of DeQuervain’s release surgery is to reduce pressure on the tendon that runs along the side of the wrist near the thumb. The surgery opens the tissue over the swollen part of the tendon. This allows the tendon to move freely without pain.

Risks of the Procedure

As with all surgical procedures there are complications that occur. For DeQuervain’s release, complications include infection and nerve damage. Before surgery your doctor will review the possible risks and complications of surgery with you.

What to Expect

Before Procedure

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear comfortable clothing.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

Your wrist and thumb will be sore and swollen at first. You may feel numbness or tingling near the incision that the doctor made. This feeling will probably start to get better in a few days, but it may take several months to go away. Your doctor will take out your stitches 1 to 2 weeks after surgery. Your doctor or your occupational therapist may recommend that you wear a splint on your hand for 1 to 4 weeks after surgery.

It may take 6 to 12 weeks for your hand to heal completely. After you heal, you may be able to move your wrist and thumb without pain.

How soon you can return to work depends on your job. If you can do your job without using your hand, you may be able to go back after 1 or 2 days. But if your job requires you to do repeated hand or wrist movements, put pressure on your hand or wrist, or lift things, you may need to take more time off work. Your doctor can help you decide how much time you will need to take.

Discharge Instructions

Diet

You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Hand Care & Bathing

Keep your dressing in place until your first post-op visit.
Dressing will be changed at your first post-op appointment.
Tegaderm dressing will be placed which will allow you to shower immediately.
No bath or swimming until the bandages are removed.
If the tegaderm dressings become loose or fall off replace with over the counter water proof bandages.
Keep incision dry until sutures are removed.

Elevation and Circulation

Elevate the extremity on pillows with fingers point toward the ceiling as much as possible for the first 3-5 days.
After these first few days, continue to elevate as needed in order to reduce swelling.
To encourage circulation and decrease swelling, wiggle your fingers, thumb and wrist several times each hour.

Cold Therapy

To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
It is not necessary to use ice while sleeping.

Pain Medication

Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
No driving while taking any narcotic pain medication!
The pain medication may cause some nausea so take it with food.
The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

Watch for temperature > 101.5F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

You will likely meet with an occupational therapist to learn strengthening exercises and help you adjust your daily routine in order to aid in rehabilitation and prevent future problems. You may also be placed in a splint to help alleviate pressure to your wrist.