Are you a mum or grandmother whose been picking up your new baby over and over and now seem to have a very painful thumb and wrist? Or perhaps you’ve had a fall onto your wrist and the area just doesn’t seem to be settling?
It could be that you’ve developed de Quervain’s tenosynovitis, an inflammation of the tendons of the thumb. And before you yell ‘sexist’ about pinpointing mums and grandmothers, you should know the condition affects women ten times more than men, but we don’t know why.
The condition’s name is attributed to Swiss surgeon Fritz de Quervain who first described it in 1895, back at a time when it was also apparently known as the very non-PC ‘washer woman’s sprain’.
Women and men with this condition can experience significant pain and discomfort when those tendons serving the thumb are utilised, or if they’re bending their wrist and causing tension across that area. And it’s not just limited to picking up babies! In a work environment, it can be attributed to overuse or a repetitive activity which causes irritation in the area or can trigger an underlying inflammatory or degenerative condition.
Whatever the cause of your de Quervain’s tenosynovitis, ultimately it will result in a vicious cycle of inflammation in that area around the base of your thumb. More activity causes more inflammation; more inflammation causes more pain.
Treatment primarily involves resting the area to allow the inflammation to settle and thereby break that cycle. This is often combined with splinting, either from a hand therapist or with an off-the-shelf device, to immobilise the thumb and stop irritation of the area. If the condition is severe, another useful treatment is a steroid injection which adds to the local anti-inflammatory effect.
If your pain fails to quickly resolve after these conservative measures, surgery can fix it. This involves a small incision into the area on the side of the wrist at the base of your thumb and a release of the inflamed tendons to allow them to glide freely. It’s a very effective operation and relatively simple but still has those risks of surgery.
There is debate about how long you should try conservative treatment before moving to surgery. Some say six months; others say six weeks. I tend to proceed to surgery quite quickly if my patient is very debilitated from constant wrist pain and finds they’re unable to do the things they want to do in their daily life. But this decision is always balanced with my patient’s wishes and if they want to go on with further conservative treatment, that’s very reasonable to do too.
However, if you can’t do the things you need to do and you have trialled conservative management for six to eight weeks, looking toward a surgical procedure may be a good way of getting your life back on track quickly.
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