DeQuervain’s Tendinitis

DeQuervain’s tendinitis is a space problem, like carpal tunnel syndrome. However, instead of a nerve getting compressed (as in carpal tunnel syndrome), this time it’s a tendon that’s getting compressed. It’s the tendons on the thumb side of your wrist. You get swelling in the tunnel that the tendons travel in, so that there’s not enough space for the tendons to comfortably pass. This leads to sharp wrist pain, just above your thumb.

It’s common in mothers with small children, who lift their growing children up a lot. This leads to tendon overuse and tendinitis. Gardeners who do a lot of weeding also develop it, as can manual laborers, or anyone else who lifts up heavy objects often.

Initial treatment is to avoid the activites that cause pain. In other words, avoid lifting with your thumb up. If you have to lift, lift with the palm up or the palm down. To lift up small kids, keep your palm up and ‘scoop under’ their bottoms to lift them. Or you can use your other hand to bear most of their weight. Splinting can be helpful. And a single steroid injection is helpful, and can often be curative, especially if you catch it early and are able to avoid repeating the stressful activities.

If those measures fail, the tendon can be surgically released through a small incision. It’s outpatient surgery, under local anesthesia and not very painful it all. Note that if a surgeon simply releases the tendons and allows early motion, the tendons can occasionally sublux (move back and forth), leading to an annoying, painful snapping. To prevent this, after releasing the tunnel around the tendons, I prefer to lengthen the fascia (the material that makes up the tunnel) and repair it with plenty of room for the tendons, like a seatbelt around them. This helps prevent subluxation. After only 1 week in a splint you can move the wrist normally, and use it within the limits of pain. I use absorbable stitches, so there are no stitches to remove. DeQuervain’s release is extremely effective and the vast majority of patients return quickly to their regular activities.

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