Why Does it Occur?
DeQuervain's disease is one of the most common disorders of the hand and appears to be increasing in incidence, likely due to the increasing overuse of our hands in our daily lives. It appears to specifically occur secondary to overuse of the tendons that control the thumb. We all use our thumbs for just about everything (it's one of the main characteristics that differentiates us from the rest of the animal kingdom!). Just like any tendon in the body that's overused, the tendon can get inflamed and lead to tendinitis. The tendons controlling thumb extension pass through tight tunnels on the radial (thumb side) of the wrist. When these tendons get inflamed, there is increased friction within the tunnels causing more inflammation and eventual pain.
DeQuervain's disease is also more common in new mothers (so much so that it is often called New Mother's Wrist). This is thought to be secondary to the cradling position that mothers put their hand/thumb into for extended periods to support the baby's head.
DeQuervain's disease is also more common in patients who have other overuse related disorders such as Carpal Tunnel Syndrome and Trigger Finger. It also occurs with more frequency in patients who have Diabetes or inflammatory conditions such as Rheumatoid Arthritis.
DeQuervain's disease often causes wrist pain at the radial (thumb side) of the wrist. This pain is worse with overuse, thumb extension, or wrist ulnar deviation. Common complaints are pain with holding a heavy object such as a gallon of milk or child, and wrist pain with grasping objects.
Dequervain's Disease is typically diagnosed clinically. An x-ray and other radiologic studies may be ordered if the diagnosis is in question or to rule other disorders.
Rest and activity modification to decrease overuse of the thumb are treatment mainstays. A thumb spica wrist splint worn full-time for 6-weeks is a good option to force rest on the thumb. In general, we ask patients to remove the splint only for washing. Patients are otherwise asked to wear the splint at all times, including sleeping.
Anti-inflammatory medications (as long as you don't have any contraindications to taking them) and cortisone injections are often helpful. Up to 3 cortisone injections, given no less than a month apart, can be safely administered to decrease tendon inflammation. Ice is a natural anti-inflammatory and can also be helpful.
Surgery may be recommended if you have not improved with non-operative treatment. The reality is that surgery is only necessary if the patient thinks it's necessary because of severe pain and functional limitations. The purpose of surgery is to increase the space available for the tendons by opening up the tendon sheaths and cleaning the tendons of inflammatory tissue (tenosynovectomy). Dr. Steven Lee performs this surgery in an average of 5 minutes and is typically performed with local or regional anesthesia in an outpatient setting. Success rates typically average greater than 95%.
After surgery, a splint will be placed on your wrist that must be kept clean and dry. The dressing is removed in office after one week. Your sutures will most likely be removed at that time. You will then be placed back into your removable velcro thumb spica splint for an additional 1-2 weeks. The fingers are free and you are encouraged to move them. Hand/physical therapy is advised once you are 2 weeks out from surgery and will take place for approximately 4-6 weeks. Therapy helps decrease scar tissue, decrease hypersensitivity, and improve range of motion. In general, patients can return their normal activities around 4-6 week after surgery.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.