Expert Treatment for de Quervain's Tendonitis at Nebraska Hand & Shoulder Institute, P.C.
Experience relief from the persistent pain of de Quervain's tendonitis with our tailored treatment options at Nebraska Hand & Shoulder Institute. Specializing in both treatment interventions for de Quervain's tendonitis, we are experts in relieving wrist tendonitis and enhancing the overall quality of life. You can learn more about de Quervain's tendonitis below, or contact us today to schedule an appointment.
Understanding de Quervain's Tendonitis
De Quervain's Tendonitis may manifest as discomfort on your wrist's thumb side, which can be attributed to the tightening of the band over two thumb-lifting tendons. Pain may radiate from the thumb's base towards the top of the forearm, often coupled with visible swelling and a grating sensation over the tendon.
This condition is nine times more common in women and often co-occurs with carpal tunnel syndrome and trigger finger. Early diagnosis and appropriate treatment can provide significant relief.
Non-Surgical Tendonitis Treatment
An initial approach to treating de Quervain's often includes the injection of a corticosteroid preparation into the tendon sheath. Cortisone injections are a common treatment, providing significant symptom alleviation within days to weeks, however they are often painful.
For cases with prominent swelling and grating of the tendon, thumb splints, and analgesics might also be prescribed for interim relief.
Unfortunately, these treatments only address the symptoms and do not provide long-term relief by addressing the cause of de Quervain’s.
Wrist Tendonitis Surgery
In approximately one-third to one-half of cases, surgical intervention is necessary. This outpatient procedure is performed under local anesthesia and has a success rate of over 90%. Patients often report that the post-surgery discomfort is less than that following a cortisone injection.
The surgical procedure entails completely cutting the pinched tendon sheath, which frees up the tendon. It's important to note that the tendon may be slightly compressed due to the pressure from the tendon sheath. This compression resolves once the tendons are given space to glide.
WARNING: MAY CONTAIN GRAPHIC IMAGES
Risks of Surgery
Potential surgical risks encompass infection (1 in 200 cases), temporary numbness due to the need to slightly move a nerve during the procedure, and possible lingering tenderness at the surgical site.
Fallacy of Work-Relatedness
Studies on development, natural history, and the treatment of de Quervain's do not tie into the workplace or the heavy use of one's hand in repetitious activity as causative.
In one series of 55 patients, 50 of the 55 patients with de Quervain's were not involved in occupations involving repetitive use of the hands or wrist (33% were retired, 29% were clerical workers, 13% were doing assembly/light work, 7% were doing heavy labor, 18% had just delivered children).
Discoloration that could be permanent from a cortisone injection.
About Corticosteroids
Corticosteroid preparations used in a medical setting are manufactured by pharmaceutical companies. These are based on cortisol, a hormone naturally produced by the adrenal glands. Increased duration of action and strength of the drug are achieved by making a slight change to the molecule.
The drugs commonly used are: dexamethasone, beclomethasone, prednisolone, and triamcinolone. They are about 25-30 times stronger than cortisol. These drugs have been used for injection since about 1951, with rare complications occurring. Non-operative "conservative" treatment of trigger finger and de Quervain's with cortisone injections may result in side effects. These include: temporary pain increase ("flare"), fat atrophy, skin depigmentation, hot flashes (in women), plus local injection pain.
Frequently Asked Question
Question: Is de Quervain’s tendinosis caused by work? I have heard that it is unlikely.
Answer: There probably is some relationship of certain tasks to the development of de Quervain’s but they haven’t been identified. Unhappy workers blaming it on their keyboard activities need to look in another direction. The thumb only strikes the space bar during typing maneuvers. That is not an activity that would be anticipated to cause any problem with the thumb, let alone de Quervain’s.
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