De Quervain’s tenosynovitis is a common condition that can greatly affect the quality of life of people suffering from thumb and wrist pain. This article details the causes, symptoms, diagnosis and treatment options, including surgery, to help you better understand this condition and its solutions.
2. What is de Quervain’s tenosynovitis?
De Quervain’s tenosynovitis is an inflammation of the sheath surrounding the thumb’s two tendons: abductor pollicis longus and extensor pollicis brevis. These tendons pass through a narrow tunnel at the base of the thumb. When this tunnel becomes irritated as a result of repetitive movements, impact or mechanical overload, it causes painful inflammation.
Anatomy involved :
- Tendons involved Long abductor and short extensor tendons of the thumb.
- Affected area Tendon tunnel at base of thumb.
- Possible complications :
- Sensitization of the radial nerve (sensitive branch).
- Formation of a cyst at the end of the tunnel.
Main causes :
- Repetitive activities (manual labor, sports).
- Trauma or direct impact.
- Hormonal changes (pregnancy, menopause).
Typical symptoms :
- Intense pain at base of thumb radiating to wrist.
- Localized swelling.
- Difficulty performing movements such as grasping objects.
In the early stages, de Quervain’s tenosynovitis can often be relieved with simple, non-invasive treatments. But sometimes, despite your best efforts, the pain persists or worsens, making even everyday movements unbearable. In such cases, surgery may be the best solution to restore your comfort and mobility.
3. Why may surgery be necessary?
In the early stages, de Quervain’s tenosynovitis can often be relieved with simple, non-invasive treatments. But sometimes, despite your best efforts, the pain persists or worsens, making even everyday movements unbearable. In such cases, surgery may be the best solution to restore your comfort and mobility.
Conservative treatments: essential first steps
Before considering surgery, several approaches can be tried to calm inflammation and reduce pain:
- Wearing a splint This immobilizes your thumb to allow the tendons to rest.
- Anti-inflammatory drugs (NSAIDs) They help reduce inflammation and relieve pain.
- Physiotherapy Gentle, targeted exercises can improve mobility and reduce tendon irritation.
- Corticosteroid infiltrations Highly effective in many cases, they rapidly calm inflammation.
When should surgery be considered?
If, despite these treatments, you continue to suffer or your condition worsens, it may be time to discuss surgery with your doctor. Here are the main reasons why you may need surgery:
- Conservative treatments did not bring any improvement after several weeks.
- The pain becomes chronic and prevents you from performing simple gestures such as grasping an object or opening a door.
- A cyst or severe irritation of the radial nerve is detected.
4. Precise diagnosis: understanding what’s going on
To determine the best treatment, it’s essential to obtain a clear diagnosis. This begins with a clinical examination by a specialist.
Clinical test: the Finkelstein test
Your doctor may ask you to perform a simple but revealing gesture: bend your thumb into the palm of your hand, close your fingers around the thumb to form a fist, then gently tilt your wrist outwards (little finger side). If this movement causes a sharp pain at the base of the thumb, this often confirms de Quervain’s tenosynovitis.
Further tests
In some cases, further tests may be necessary to rule out other possible causes or to better understand the extent of the problem:
- An X-ray to check for bone abnormalities.
- Ultrasound to visualize inflammation or detect tendon thickening.
- An MRI if the case is complex or if a cyst is suspected.
5. The surgical procedure
If surgery is necessary, don’t worry: it’s a common and rapid procedure, usually performed on an outpatient basis.
5.1 Before the operation: preparing well
First and foremost, a pre-operative consultation enables the surgeon to confirm the diagnosis and answer any questions you may have. If necessary, examinations such as ultrasound or MRI will be carried out to pinpoint the exact location of the inflammation or identify any complications (such as cysts).
5.2 During the operation: what happens in the room
The procedure is performed under local or regional anesthesia, which means you’ll be awake but without feeling any pain in the area concerned. Here’s how it works:
- A small incision is made in the tendon tunnel (at the base of the thumb).
- The sheath surrounding the tendons is opened to eliminate the friction responsible for the inflammation.
- If necessary, the radial nerve is released in the event of severe irritation.
- If a cyst is present, it will be removed during the same procedure.
5.3 After the operation :
Finger and wrist mobilization is often immediate, except in cases of severe inflammation requiring a temporary splint.
6. Expected results and prognosis
High success rate :
The surgery offers an excellent success rate (>90%), with a significant reduction in pain and full recovery of thumb and wrist function within weeks of surgery.
Possible complications:
Although rare, certain complications can occur:
- Residual scar sensitivity.
- Exceptional recurrence.
- Temporary irritation of the radial nerve.
7. Frequently asked questions (FAQ)
How much does this procedure cost?
The cost varies from institution to institution and country to country, but is generally covered by health insurance in the case of disabling conditions.
Can tenosynovitis return after surgery?
Recurrences are rare if repetitive procedures are avoided after surgery.
How long does it take to return to work or sport?
Daily activities can be resumed as soon as a few days after the operation, but it is necessary to wait 3 to 4 weeks before resuming intensive activities.
Is it painful after the operation?
Mild pain may persist for a few days, but is well controlled with simple analgesics.
9. Conclusion
De Quervain’s tenosynovitis is a painful but perfectly treatable condition, thanks to appropriate conservative or surgical approaches. If you suffer from persistent symptoms, consult a specialist as soon as possible to avoid aggravation and regain your quality of life. <
