By: Ricardo E. Colberg, MD
What is de quervain tenosynovitis?
This is a common condition in patients who do repetitive gripping, twisting, and lifting with their hands. The tendons that extend the thumb run under a ligament, the extensor retinaculum, which keeps the tendons in place. In some cases, the tendons can get swollen with inflammation and develop a nodule that starts catching and popping under the ligament. In severe cases, the tendon can get so swollen that it will get stick and will not flex/extend the thumb anymore.
What are conservative treatments for de quervain tenosynovitis?
Frequently, the patient is offered a course of hand therapy to try to restore the full range of motion in the wrist. In addition, anti-inflammatory medications and a steroid injection may be offered to treat the pain and inflammation. A wrist brace may also be offered to allow the tendon to rest.
Is there a “permanent fix” or a surgical option?
For many years, the “permanent fix” was surgery through an open incision was made to cut the extensor retinaculum. However, this technique requires stitches, wound care, and prolonged return to work due to the wound healing, up to 6 weeks for full lifting. There is also potential for complications from the surgical healing, including pain and tendon instability.
Now, there is a minimally invasive technique to do the same release that does not require a surgical incision. It is called a percutaneous first dorsal compartment release under ultrasound guidance. This procedure consists of injecting lidocaine to numb the skin, making a small skin puncture using a needle with a tiny blade at the tip, and then advancing the needle to release the retinaculum under live ultrasound imaging. Since the skin is not cut open with a scalpel, the recovery is much quicker with a much lower risk of pain, scar tissue, infection or tendon instability. The patient can immediately use the hand afterwards. The patient will keep a bandage over the area for only 24 hours and does not have to worry about getting stitches removed.
In 3 days, the patient can resume light gripping, and can return to full gripping as soon as 2 weeks. In addition, this procedure is cheaper than open surgery since it is done in the office and does not require paying for Surgery Center fees.
Pre-Procedure Instructions
1. Stop anti-inflammatory (NSAIDs) medications 3 days prior to procedure (e.g. ibuprofen, naproxen, etc;).
2. In some cases, you may need to stop blood thinners (e.g. Aspirin,
Plavix, Coumadin, etc.) 3 days prior to procedure. You must discuss this
with Dr. Colberg, as well as your cardiologist or primary doctor and
obtain approval. Other daily medications should be taken normally as
directed.
3. Arrange for a friend or family member to provide transportation for
you on the day of the procedure. Post-procedure anesthesia will
interfere with your ability to drive.
Post-Procedure Instructions
1. Blood thinners (e.g. Aspirin, Plavix, Coumadin, etc.) may be resumed 24 hours after the procedure.
2. The band aid may be removed 24 hours after the procedure. Do no soak
the wrist in water for a prolonged period of time (i.e. swimming,
jacuzzi, etc;) for three days.
3. Increased irritation in the affected area may occur. Ice the affected
area three to four times per day for 15 minutes for the next three
days. You may take Extra Strength Acetaminophen as needed for pain or
the prescribed pain medication.
4. We encourage you to move the wrist as tolerated during the day to
stimulate the area to heal appropriately. Limit light gripping for 3
days and heavy gripping for 2 weeks, as tolerated.
5. If you
develop fever, persistent redness and swelling at the site of injection,
call Dr. Colberg’s office at (205) 939-3699. These may be a sign of
infection.
Andrews Sports Medicine provides the most-advanced, comprehensive treatment solutions for injuries and disorders of the hand and wrist. To schedule an appointment, call (205) 939-3699.
