De Quervains Disease Is a condition where two of the tendons to the thumb become pinched in one of the tight tunnels on the back of the wrist.
These two tendons are called Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). in some people there will also be some inflammation.
There is a very sensitive nerve which runs over the area where the tendons get caught, called the superficial radial nerve and this can also be irritated and give a toothache type sensation down the back of the thumb and the index finger.
This condition tends to effect ladies, particularly postpartum, diabetics and can be associated with excess use.
Splints can be really useful and would be the first line of treatment in almost everybody. If you are getting this from a nonspecialist please be aware that the splint must go across the wrist and include the thumb. If it omits either of these two then it will not work. Also be aware that sometimes the splint can be uncomfortable as it can press on the area where the tendons are trapped. if you find the splint is helping after a week or two then it may mean that you need a different type of splint. Don’t give up! Remember splints can be a work in progress that can be adjusted to suit you and your particular needs.
Steroid injections will normally get rid of the symptoms either temporarily or permanently. The problem with steroid injections here are that you can get significant skin depigmentation which is cosmetically very unattractive and may be permanent. It can also lead to thinning of the skin and in rare occasions lead to chronic bruising of this area. Steroid injections are often used in conjunction with splints.
Surgery Is normally performed under local anaesthetic. The scar can vary between transverse, longitudinal or zigzag. The surgery involves releasing the roof of the tight tunnel that the two tendons are trapped in to allow the tendons to move freely. It may be necessary for some synovitis to be removed. The main thing to look for in surgery is the superficial radial nerve which needs to be mobilised out of the way and protected at all times. The next point is that there are often more than just the two tendons described in the textbooks ( anatomical studies say between three and eight tendons are normally found). Therefore it is important for said compartments where secondary slips of these tendons might be trapped still.