Is Wrist Surgery Necessary for De Quervain’s Tendonitis?

Sports enthusiasts who enjoy activities like golf, tennis, or rowing are particularly susceptible to a disorder known as De Quervain’s tendonitis.  So are others who consistently use their hands in repetitive motions.  When this condition cannot be successfully treated with conservative measures, wrist surgery performed by a hand surgeon is sometimes necessary.

What is De Quervain’s Tendonitis?

It is an inflammation of the wrist tendons at the base of the thumb, according to The Ohio State University.  A hand surgeon might also call it first dorsal compartment tendonitis, De Quervain’s tendinitis, or De Quervain’s tenosynovitis.  All of these refer to a condition that causes the tunnel surrounding tendons to swell, making movements of the wrist and thumb painful.  Even making a fist or grabbing an object can cause pain.

The most common cause is chronic overuse of the hand and the wrist in sports and in activities like gardening or keyboarding.  Hormonal shifts in pregnant and nursing women make them especially prone to this condition.

MedlinePlus indicates that the most dramatic symptoms include:

  • Pain on the back of the thumb when turning the wrist, grabbing an object, or making a fist
  • Numbness in the index finger and thumb
  • Wrist swelling
  • Stiffness when trying to move the wrist or thumb

If this condition goes untreated too long, the result might be pain further into the thumb, in the forearm, or in both places.  Almost any pinching or grasping motion will aggravate the pain.

How Does a Hand Doctor Treat It?

A hand specialist performs a physical exam to note if there is pain when applying pressure to the thumb side of the patient’s wrist and diagnose De Quervain’s.  According to the Mayo Clinic, a hand doctor also performs a Finkelstein test to assess where pain occurs when bending the thumb and fingers a certain way.  Imaging studies like X-rays are usually unnecessary.

The goal of treatment is reducing inflammation, preserving movement in the patient’s thumb, and avoiding a recurrence.  With early intervention, most symptoms improve within six weeks.

Before suggesting hand surgery, a physician normally recommends more conservative treatments:

  • Over-the-counter medications like ibuprofen or naproxen to relieve pain
  • Corticosteroid injections to reduce swelling
  • Immobilizing the wrist and thumb with a brace or a splint
  • Avoiding repetitive motions of or pinching with the thumb
  • Applying ice
  • Exercise to strengthen muscles, curtail tendon irritation, and cut pain

When these measures fail, a hand surgeon might advise outpatient surgery.  During this procedure, the physician looks at the tendon sheath and then opens it using a small incision over the wrist.  The objective is releasing pressure in order to allow the tendons to move freely.

Patients return home wearing a splint.  Most achieve full use of the hand and wrist within four to six weeks after the procedure.