The Condition
The cause of pain at the base of your thumb / wrist is due to thickening of the
lining that tendons run through. All tendons run through a lubricated lining, and
if the tendon lining becomes thickened, then, instead of the tendon gliding smoothly,
it rubs and causes inflammation, which causes pain and tenderness. A tendon lining
which is inflamed is called a tenosynovitis. De Quervain was a French Surgeon who
first discovered the condition.
A steroid injection can be curative.
The Operation
The operation releases the tight area of tendon sheath, and allows the tendon to
glide freely and comfortably. After the operation the small wound is closed with
glue or stitches.
During surgery, after the actual operation is finished, local anaesthetic is put
in the wound. This makes your hand numb for 6 – 12 hours and there is only a mild
ache when the effect wears off.
You will find that the pain that you had before surgery will go within a matter
of 24 hours and you will be quite free to use the hand and thumb fully.
After the Operation
We usually put on a small dressing under the large wool land crepe bandage. You
can remove the big bandage yourself the day after the operation, but keep the small
dressing on. This will allow you to start using the thumb more freely. You need
to keep the small dressing on and the hand dry for 10 days after the operation,
whilst the wound is healing.
If we have used stitches, they will be removed ten days after surgery and you need
to keep the hand dry until that time. Exercising in warm to hot water after removal
of the stitches is useful to regain movement. Use of E45 cream to massage the hand
and keep the skin soft is helpful.
Risks of Surgery
- Complications can include irritation of small nerves in the area of the wound.
This usually settles week-by-week, and goes by 6 weeks after surgery. Occasionally
treatment is required if the sensitivity continues. This occurs in less than 1%
of all operations. Occasionally the tendon sheath (the tendon lining) regrows very
rapidly and surgery is needed again but this is in less than 0.5% of operations.
Because of the delicate nature of this particular operation, it is always done by
your Consultant, Mr AW Samuel, and not a junior member of the team.
- Infection can occur – as after any cut in the skin, this occurs in about 1% of
all operations.
- Circulation disturbance (sympathetic dystrophy or regional pain syndrome) can
occur in approx 1% of all operations. Prompt treatment with medication or injection
is usually very effective. You will be reviewed regularly after surgery so this
or any other complication, is treated promptly.
References
Green – Textbook of Hand Surgery
Bulstrode – Textbook of Orthopaedic Surgery
Internet sites:
www.mayoclinic.com www.orthogate.com
In the UK patients need to have their General Practitioner's permission for a referral.
This can be done by means of a phone call after you have described your symptoms , your G.P. will then send a referral letter to my secretary and we will contact
you. Please note the majority of Insurance Companies insist on a GP referral before you are seen.
After you have contacted your G.P. a convenient appointment will be made.
I consult at:
- Sarum Road BMI Private Hospital
- Wessex Nuffield Hospital
- London Bridge Hospital
(For surgery locations please click
here)
Any operative treatment would usually be done at Sarum Road Hospital. Emergency treatment can be carried out on any day.
My secretary can be contacted on Tel. 01962 777616. Futher contact details please click
here.
If my secretary is unavailable you will receive a prompt reply to your answerphone message.