• De Quervain's Tenosynovitis

    De Quervain’s Tenosynovitis is a painful inflammation of tendons on the side of the wrist at the base of the thumb.

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    Dr. Bertrand Perey, MD, FSRC, Orthopaedic Surgeon, talks about De Quervain's Tenosynovitis and what to expect if you are diagnosed with the condition.
    Dr. Bertrand Perey, MD, FSRC, Orthopaedic Surgeon, talks about De Quervain's Tenosynovitis and what to expect if you are diagnosed with the condition.
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    Dr. Herb Von Schroeder, MD, FRCSC, Orthopedic Surgeon, talks about Dequervain's Tenosynovitis and the various treatment options available to patients.
    Dr. Herb Von Schroeder, MD, FRCSC, Orthopedic Surgeon, talks about Dequervain's Tenosynovitis and the various treatment options available to patients.
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  • Understanding De Quervain's Tenosynovitis

    Dequervain's Tenosynovitis or tendinitis is a painful condition that affects the two tendons that travel to the thumb through a small tunnel on the side of the wrist that we call the radial side. These two tendons move the thumb so it's painful when trying to bend the thumb up and down and especially when bending the thumb across the palm towards the small finger. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option.  

    The pain is due to inflammation and swelling at the tunnel and its tendons on the radial side of the wrist. It is more common in middle age, but it also occurs in younger patients and can be worse during and immediately after pregnancy. Relatively minor injury can sometimes trigger the condition. The pain may appear either gradually or suddenly. The pain is aggravated with the use of the thumb and the pain can radiate up into the forearm and to the elbow.

    The first treatment for Dequervain's Tenosynovitis is to modify the activities that cause the pain and to use a splint from the forearm across the wrist and up the thumb. The splint immobilizes the wrist and immobilizes the thumb to help the inflammation.

    Anti Inflammatory medications such as Advil or Naproxen can be of benefit to help reduce the swelling and the pain. If the problem fails to resolve within a few weeks, then a corticosteroid injection or a cortisone injection is often recommended. Injections are performed right at the tunnel that carries the tendons to the thumb. The improvement of the symptoms is usually felt between three to seven days following the injection. The relief usually continues over six to eight weeks.

    Cortisone injections are very safe but all medicines have side effects. Cortisone injections can cause temporary loss of pigmentation of the skin around the injection site. This can be particularly noticeable in patients with darker skin. Furthermore, the cortisone can cause thinning of the skin. Usually, these issues do resolve with time.

    Unfortunately, about 1/3 of patients can have recurrence of their symptoms after the injection despite a period of improvement. A second corticosteroid injection can be recommended. A patient with diabetes or those with more advanced chronic symptoms will likely have a higher rate of failure with a cortisone injection. If symptoms don't improve with one or two injections, then surgery is generally recommended.

    Surgery involves opening the tendon tunnel to the thumb and is usually done with a local anesthetic in an outpatient care setting, much like going to the dentist. Although surgery is highly successful, recovery from surgery is slower than the recovery following a corticosteroid injection. It is possible for patients to experience temporary numbness into the thumb following the surgery, but this usually does resolve with time. The surgical incisions is closed with either absorbable or non absorbable sutures.

    After the surgery there's a light dressing on the wound and this should stay in place for about two to three days. At this point, the wound should be washed with soap and water. Patients are asked to avoid soaking and must keep it clean for about 10 to 14 days. All operations do have risks and your surgeon will discuss these with you.

    To summarize, Dequervain's Tenosynovitis is the pain and inflammation of the thumb tendons on the inner tunnel on the side of the wrist. It can be treated in three ways, a splint from the forearm to the thumb, a cortisone injection, or surgery, and each treatment has different effectiveness. You'll decide on your treatment plan by talking to your doctor. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

    Thank you.

    Presenter: Dr. Herb Von Schroeder, Orthopaedic Surgeon, Toronto, ON

    Local Practitioners: Orthopaedic Surgeon

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