De Quervains Tenosynovitis Treatment
Treatment for de Quervains tenosynovitis focuses on reducing pain and swelling. It includes:
- Applying heat or ice to the affected area.
- Taking a nonsteroidal anti-inflammatory drug . These include ibuprofen or naproxen .
- Avoiding activities that cause pain and swelling. Especially avoid those that involve repetitive hand and wrist motions.
- Wearing a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.
- Getting injections of steroids or a local anesthetic into the tendon sheath. These injections are very effective and are used regularly.
A physical therapist or occupational therapist can show you how to change the way you move. This can reduce stress on your wrist. He or she can also teach you exercises to strengthen your muscles.
Most people notice improvement after 4 to 6 weeks of treatment. They are able to use their hands and wrists without pain once the swelling is gone.
Recovering From De Quervains Tenosynovitis Surgery
The purpose of surgery for De Quervains tenosynovitis is to open the compartment that encases the inflamed tendons, so they can move freely without causing pain. The surgery is common and highly successfulthose who undergo it can boost chances for success even more by following these instructions and care tips during recovery.
How Is It Diagnosed
The diagnosis of carpal tunnel syndrome is made primarily by clinical examination and the patients history of symptoms. It is important to remember that not all wrist and finger pain is CTS. In addition, not all finger numbness or tingling is CTS. Confirmation of the diagnosis with the use of nerve electrodiagnostic testing is often useful.
Electrodiagnostic testing, made up of nerve conduction and testing, is used to confirm the diagnosis of carpal tunnel syndrome and other nerve disorders. Nerve conduction studies evaluate the conduction of electrical signals through the median nerve in the carpal tunnel and into the associated muscles. A conduction block, or slowing of the electrical signal through the nerve as it courses through the carpal tunnel, can be compared to the reduced flow of water through a garden hose that has a kink in it. This reduced flow of electricity results in the altered sensation and muscle weakness associated with this syndrome.
EMG testing studies the muscle itself. By examining how the muscle depolarizes when activated, it can be determined if the nerve input to that specific muscle is working properly. Very subtle loss of muscle function can be determined long before the patient experiences any subjective loss in strength, making this portion of the test very important for detecting early nerve damage.
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Potential Risks And Complications
Complications are rare, but all surgery involves some potential risks and complications. The potential complications for this procedure include:
- Infection at the incision site
- Damage to the radial nerve , though this is usually temporary
- Tenderness on the incision site
- Displacement of the tendons, causing a snapping or catching sensation in the wrist
Patients can decrease their risk for complications by following their post-surgical care instructions.
Medical attention is needed if any of the following symptoms occur:
- Tingling or numbness in hands or fingers
- Significant bleeding from the incision or the incision opening
- Inability to move fingers
- Signs of an infection, which include:
- Pus from the incision
What Is De Quervains Tenosynovitis Also Known As De Quervains Syndrome
There are two tendons that extend the thumb: Abductor pollicis longus and Extensor pollicis longus . As these tendons travel from the forearm into the hand, they run through a tight tunnel. The tunnel is part of the extensor retinaculum, a broad ligament that binds the tendons down against the forearm, and allows the tendons to work efficiently. The tunnel and the tendon are covered with a layer of tissue called tenosynovium to help the tendons glide as they move through the narrow tunnel.
In De Quervains tenosynovitis, inflammation of the tenosynovium narrows the tunnel. This means that the two tendons do not move easily but graunch and grind their way through, which is very painful.
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What Are The Symptoms Of Carpal Tunnel Syndrome
Symptoms usually begin slowly and can occur at any time. Early symptoms include:
- Numbness at night.
- Tingling and/or pain in the fingers .
In fact, because some people sleep with their wrists curled, nighttime symptoms are common and can wake people from sleep. These nighttime symptoms are often the first reported symptoms. Shaking the hands helps relieve symptoms in the early stage of the condition.
Common daytime symptoms can include:
- Tingling in the fingers.
As carpal tunnel syndrome worsens, symptoms become more constant. These symptoms can include:
- Weakness in the hand.
- Inability to perform tasks that require delicate motions .
- Dropping objects.
In the most severe condition, the muscles at the base of the thumb visibly shrink in size .
Does Carpal Tunnel Syndrome Only Happen To Office Workers Or Factory Workers
No. Many people with carpal tunnel syndrome have never done office work or worked on an assembly line. It affects people who use their wrists and hands repeatedly at work and at play. Anyone can get carpel tunnel syndrome, but it is unusual before age 20. The chance of getting carpal tunnel syndrome increases with age.
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Make An Appointment For A Hand Consultation With Dr Gittos
If you have any symptoms that might be part of De Quervains syndrome, give us a call to make an appointment with Dr. Mark Gittos in Auckland, New Zealand. Dr. Mark is a plastic surgeon who is experienced in treating hand disorders, such as trigger finger, De Quervains syndrome, cubital and radial tunnel syndromes, carpal tunnel syndrome, ligament disorders, and tumours or ganglions. Come visit us to get a full assessment of your conditon and learn about your treatment options.
Other Names For De Quervain’s Syndrome
While this condition has been known for well over a century, it’s many names describe it’s prevalence in our modern world. For example, de Quervain’s Syndrome also goes by:
- de Quervain’s stenosing
- designer’s thumb
In 1895, a Swiss surgeon named Fritz de Quervain saw patients with a pattern of thumb pain symptoms. They also had similar histories that might cause the pain. He was the first to describe the problem as one condition. Dr. de Quervain also described the underlying anatomy and pathology. Thus, the condition now bears his name.
Today, we know that de Quervains Syndrome pain is relatively common. In the working population,it affects about 0.5 % of males and 1.3 % of females.
Many people confuse de Quervain’s Syndrome withcarpal tunnel symptoms.These two conditions share some similarities, but they’re quite different.
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Common Hand Injuries For Musicians
Did you know that estimates say around 76% of musicians will suffer some type of injury throughout their life that impacts their playing ability?
Playing an instrument is a hobby for some, an outlet for others, and even potentially a career for people. It has countless benefits, but as you can see from the above figure, it can also bring unwanted hand pain.
Do you play an instrument? Have you ever experienced pain beyond the mini aches that come from exerting your hands to play?
Suffering for your art is a real thing, so continue reading to learn seven of the most common hand injuries that plague musicians so that you know what to expect, the signs to look for, and what you can do if you find yourself dealing with musician hand pain.
When De Quervains Tenosynovitis Surgery Is Your Best Option
When conservative management of De Quervains syndrome fails, surgery is indicated, says Dr. Amin Afsari, D.O., and hand and wrist specialist. Surgical release of the tendons has been shown to provide excellent long-term relief for this condition.
If surgery is necessary, you can expect an outpatient procedure. Your surgeon will make a small incision in your wrist to release or disconnect the area of the tendon that wraps around the base of your thumb. When the swollen tissue surgically moved out of the way, the tendon can move smoothly, without causing pain. Typically, patients recover from this surgery in six to eight weeks, depending on their occupation. Some patients can return to work with a splint within days. You may need to take a medical leave of absence from work for the first week following surgery.
The good news is that you can mitigate your chances of developing a repetitive motion condition like De Quervains by identifying hand and wrist overuse, taking breaks, and regularly exercising to maintain strength and flexibility. Awareness of how you treat your hands and wrists can make all the difference.
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Surgery For De Quervains Tendinitis
If none of the above therapies are successful, surgery may be necessary. Doctors will consider a patient for surgery once they meet 3 main criteria. These criteria are when the patient:
- Still has severe pain and,
- Has tried all self-treatments unsuccessfully, and
- Had a course of steroid shots with no success.
Doctors normally perform this surgery on an outpatient basis. Doctors call the surgeryde Quervains Release. It involves making a 1-2 inch incision on the outside of the thumb area, over the swollen tendons.
Then the surgeon frees up the tendons from any adhesions around them. Doing so gives the tendons more room to glide smoothly. Recovery can take a few weeks to months, depending on several factors. Chief among them is your overall health.
When Surgery Is Needed For De Quervains Tendonitis
If none of the above therapies are successful, surgery may be necessary. Doctors will consider a patient for surgery once3 main criteriaare met. These criteria are when the patient:
- Still has severe de Quervain’s Syndrome pain and,
- Has tried all self-treatments unsuccessfully, and
- Was given a course of steroid shots with no success.
Doctors normally perform this surgery on an outpatient basis. The surgery is calledde Quervains Release.It involves making a 1-2 inch incision on the outside of the thumb area, over the swollen tendons.
Then the surgeon frees up the tendons from any adhesions around them. Doing so gives the tendons more room to move.
Recovery can take a few weeks to months, depending on several factors. Chief among them is your overall health.
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What Other Conditions Can Cause Similar Symptoms
Several of them. One, which doctors call de Quervain tenosynovitis, causes problems with the tendons that control your thumb. It hurts to turn your wrist, make a fist, or try to grasp an object. Your doctor can do some simple tests to tell whether you have this condition or carpal tunnel.
Other health problems that may seem like carpal tunnel syndrome include:
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Dr DURAND is the only fellowship trained hand surgeon, Board Certified in Canada and the United States, with 25 years of hand surgery experience, and is a former associate professor at McGill University , and former Examiner for Royal College of Physicians and Surgeons of Canada.
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Diagnosis Of A De Quervain Syndrome
In the case of a De Quervain syndrome, irritation often begins after an unusual or intensive activity, or a knock. The membranes surrounding the tendons increase in volume, and proceed to rub against the interior of the tunnel, and the mechanism continues of its own accord.
Diagnosis is made on clinical examination. Pain is predominant on the outer bort of the wrist. Sometimes a painful nodule may be detected on palpation of the zone. Some movements, such as the gesture of inclining the wrist to the opposite side and raising the thumb against opposition, may aggravate the pain.
Further examinations are not necessary.
Treatment Options For Trigger Finger
There are different treatment options for this condition and these will be discussed in detail at your consultation. These options include
Splinting which holds the finger in a straight position.
Steroid Injection this does relieve symptoms in the majority of cases, however, often several injections are required. Surgery may be required if further triggering persists.
Surgical decompression of the tendon surgical intervention for treating this condition will be required if non-surgical options have been unsuccessful. The decision to proceed with surgery will be dependent on how much pain or loss of function you have. Surgery will be conducted under local anaesthetic and involves your surgeon making a small incision in the palm of the hand to remove the fibrous tissue affecting movement in the finger.
Any potential complications will be discussed with you by your Consultant prior to your surgery along with any specific measures to help prevent complications.
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How Do We Treat It
Most people respond well to a trial of corticosteroid injections and immobilizing the wrist and thumb for a period of time. These injections help soothe the inflammation surrounding the tendons and many have complete relief of their symptoms. If symptoms recur or worsen, then surgery may be considered.
How Doctors Diagnose De Quervains Tendonitis
The best way for your doctor to diagnose de Quervains Syndrome is by using the Finkelstein test. This is a very simple, yet very reliable method. Start by laying your thumb across your palm. Next, make a fist with your thumb inside.
Finally, bend your wrist in the direction of your little finger. If you have de Quervains Syndrome, doing so will feel tender or painful near your thumbs base or near the wrist.
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What Are The Chances Of Pain Alleviation And Recovery After Surgery
While the surgical release of the transverse carpal ligament has risks, most patients have significant relief of pain, numbness, and tingling. If treatment is administered early enough to preserve nerve function, the most obvious improvement in the patient is pain relief — particularly nighttime pain. There is often dramatic improvement even the first night after surgery, notes Dr. Daluiski.
If a carpal tunnel release is performed after significant denervation has led to atrophy of the thumb muscles, the surgery will not improve the loss of muscle strength. Once the muscle is denervated, it is impossible for the nerve to form a new connection to the muscle. While sensation in the hand can sometimes improve following surgery, muscle strength and motor function do not. However, recurrence of CTS symptoms after surgery is rare.
De Quervains Tenosynovitis Treatment Without Surgery Or Injections
De Quervains Tenosynovitis is common tendonitis of the wrist and a leading cause of wrist and thumb pain. Tendons of the abductor pollicis longus and extensor pollicis brevis muscles pass in their synovial sheath in a fibro-osseous tunnel at the level of radial styloid. Inflammation of the synovium at this level causes pain at the radial side of the wrist.
Local tenderness and swelling may extend into the hand or forearm along the course of the tendons. Crepitus may be felt with movements of the wrist in some instances. Positive Finkelsteins test is diagnostic for De Quervains tenosynovitis. The thumb is bent and placed in the palm while the wrist is slowly brought towards the ulnar side. Pain can be felt at the base of the thumb near the radial styloid.
This radial-sided tendinopathy is very common in athletes, especially those who participate in racquet sports, ten-pin bowlers, rowers, and canoeists. Additional stress is exerted on the left thumb of a right-handed golfer during a golf swing, resulting in injury and pain.
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What Are The Symptoms
- Tingling in hands
- Numbness in hands
If you have severe symptoms that interfere with your day-to-day life or make it hard to sleep at night, its likely a good idea to visit a doctor that can assess the situation and see what the next steps might be.
No matter the severity of your carpal tunnel syndrome, here are some exercises to help.
What Is The Difference Between Carpal Tunnel Syndrome And Tenosynovitis
Carpal tunnel syndrome and tenosynovitis both cause pain in the wrist. The pain or symptoms of carpal tunnel syndrome is caused by compression of the median nerve at the wrist. Radial nerve entrapment and ulnar nerve entrapment may also cause pain in the hand and thumb regions. In tenosynovitis, the pain is due to inflammatory changes in the adductor muscle of the thumb. Moreover, carpal tunnel syndrome causes pain, numbness, and tingling in the wrist, palms, and fingers except for the 5th finger. Tenosynovitis is confined to the side of the wrist and thumb only.
Our treatments are through the best and most effective means of conservative therapies for De Quervains tenosynovitis. The care you get from us may include splinting the wrist and thumb to prevent further damage from excessive movements. Local electrotherapeutic modalities help reduce swelling and inflammation. Manual therapy such as stretches and trigger point therapy can relax the forearm muscles. Graduated strengthening exercises for the muscles in the wrist and hand are essential to prevent the recurrence of the condition.
For more information about our De Quervains Tenosynovitis treatment in Malaysia, please call 03 2093 1000.
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How Is Carpal Tunnel Syndrome Treated
Carpal tunnel syndrome can be treated in two ways: non-surgically or with surgery. There are pros and cons to both approaches. Typically, non-surgical treatments are used for less severe cases and allow you to continue with daily activities without interruption. Surgical treatments can help in more severe cases and have very positive outcomes.
Non-surgical treatments are usually tried first. Treatment begins by:
- Wearing a wrist splint at night.
- Taking nonsteroidal anti-inflammatory drugs, such as ibuprofen.
Other treatments focus on ways to change your environment to decrease symptoms. This is often seen in the workplace, where you can make modifications to help with carpal tunnel. These changes might include:
- Raising or lowering your chair.
- Moving your computer keyboard.
- Changing your hand/wrist position while doing activities.
- Using recommended splints, exercises and heat treatments from a hand therapist.
Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease the pressure on the nerves and tendons that pass through the space. This is done by cutting the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.
If you have surgery, you can expect to: