Quervain’s tendonitis

What is de Quervain’s tendonitis?

Quervain’s tendonitis is an irritation of the tendons of two thumb muscles (abductor pollicis longus and extensor pollicis brevis) which pass through a tunnel in the wrist. It is frequently the result of repeated wrist movements, but a direct blow to the tunnel or a twist of the wrist can also be responsible. This pathology can affect young mothers due to the repetitive movements involved in caring for their child.

Diagnosis of de Quervain’s tendonitis

The main symptom is pain in the wrist slightly above the base of the thumb, and the painful area may be swollen. Tilting the wrist to the side of the little finger or gripping objects with force causes pain.

A simple examination of the hand is usually sufficient to make the diagnosis. In case of doubt, an ultrasound scan can be performed. This painless examination shows a thickening of the tendon sheaths around the tendons in the tunnel.

How is tendonitis treated?

Non-surgical treatment initially involves resting the wrist and thumb in a splint, to avoid repetitive movements that irritate the tendons, and taking anti-inflammatory medication for one to three weeks. Physiotherapy or occupational therapy can sometimes be helpful. If these simple measures fail, an injection of cortisone into the tendon canal may be necessary. This procedure is performed during the consultation and lasts just a few seconds. In resistant or recurrent forms, when conservative treatment is not effective, surgery is proposed.

The procedure consists in performing an outpatient operation under local anesthesia (only the operated area, performed by the surgeon) or locoregional anesthesia (the hand and part of the forearm, performed by an anesthesiologist), during which the surgeon simply cuts or widens the wall of the tunnel through which the tendons pass. The wrist is usually immobilized for a few days in a splint, leaving the fingers free, then the sutures are removed after two weeks, unless they are absorbable, in which case they fall off by themselves. The length of time off work depends on the profession, varying from one to four weeks. Sports activities requiring the use of the operated hand should be avoided for one month.

What are the possible complications?

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Specific features of de Quervain’s tendonitis

Recurrence is rare, but may require further surgery.

The instability of the released tendons may cause a feeling of tightness in the operated area during wrist and thumb movements. This is a rare complication that may require further surgery in cases of significant discomfort.

Irritation of a superficial nerve branch caught in the scar may prove annoying, requiring occupational therapy or even re-operation to free the nerve from adhesions.