Without treatment, the pain can limit activities and motion. The pain can radiate into the hand and up the forearm. In order to eliminate pain, a hand surgeon will work with a patient to relieve the inflammation and swelling of the tendons.
The physician may recommend that a patient wear a splint to rest the thumb and wrist. Your hand surgeon may choose to inject steroids into the tendon sheath to help reduce swelling and relieve the inflammation.
Anti-inflammatory medications, such as Advil or Motrin, may help reduce the inflammation and alleviate the pain as well. Occasionally the pain will go away on its own if a patient avoids activities that cause the inflammation. Surgery may be the recommended treatment for pain relief when non-operative methods are not successful.
During surgery, your hand surgeon will make an incision on the wrist and use precision instruments to open the tunnel that encases the tendons to create additional room for the irritated tendons. Once the tunnel is open the pressure on the tendons is relieved. Without constant pressure the inflammation can subside. This is an outpatient procedure and patients typically return home in just a few hours.
Once healed, full function of the hand can resume once comfort and strength levels have returned. I will apply a light dressing and provide you with an information sheet about wound care and exercises. You may drive a car at about a week, provided your wrist is comfortable and you are able to control a motor vehicle safely.
Possible problems include swelling, bruising, bleeding, blood collecting under the wound haematoma , infection and splitting open of the wound dehiscence.
The scar may become a little thickened and red as it heals, but this will settle with time. The scar will be tender, and this will also resolve. Once your wound is healed, tape on the wound for 6 weeks, followed by firm massage with a plain cream or oil will help optimise the scar.
There are small nerve branches that run in the area of the incision. The nerve can occasionally be damaged during the operation, and this may leave either a numb patch on the back of your thumb, or a small tender point that may need another small operation to excise the tender spot. Exercises should resolve this. If you do not have a hand therapist, I will recommend one during our follow-up consultation, or you can read more about the hand therapists I refer to frequently.
Treatment for de Quervain's tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence. If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain's tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.
To reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen Advil, Motrin IB, others and naproxen Aleve. Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists.
Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation. If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.
Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.
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