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Other Conditions & Treatments:
Carpal Tunnel Syndrome
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Trigger Finger
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Ganglion Cyst
Cubital Tunnel Syndrome
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Mallet Finger
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Tennis Elbow
DeQuervain's Disease
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Dupuytren's Contracture or Disease
Basal Joint Arthritis of the Thumb
DeQuervain's disease is a common tendonitis that causes pain along the radial aspect (thumb side) of the wrist. There are two tendons attaching to the thumb that pass through a narrow tunnel, or sheath, located at the wrist. Swelling around those tendons leads to a tendonitis at this location. It can be brought on by a variety of activities, and may be work related if the occupation involves frequent or repetitive motion of the wrist or thumb. It is quite common in women soon after delivering a baby, thought to be in large part to constant lifting of the new child.
Treatment is broadly divided into three levels:
Level One:
- A splint that immobilizes the wrist and thumb is used to rest the affected tendons. Initially, the splint should be worn at all times except for showering. After 2 to 4 weeks, if symptoms are improving, then the splint is gradually worn less and less. The splint should be worn for all heavy or repetitive activities until the symptoms are resolved
- Ice can be used over the affected area for 5 to 15 minutes. Ice is most effective when used right after the activity.
- Moist heat may be useful at other times, including late at night or even before the activity.
- Anti-inflammatory medications may be useful in decreasing inflammation and swelling around the tendons. All anti-inflammatory medicines have possible side effects, and should be used on a short time basis whenever possible. Over the counter medications such as Advil, Motrin, and ibuprofen can be used with a suggested dose of two 200 mg tablets three times a day, taken with food or milk. For people with sensitive stomachs, prescription anti-inflammatory medications can be used which are more protective of the stomach. Care should be taken that these medications do not conflict with other medications (such as blood thinners) or other medical conditions (like asthma).
- Activities should be modified as needed. If there is one particular activity that causes or aggravates this tendonitis, then that activity needs to be altered or stopped. This may include different ways of picking up and holding babies, or altering work stations.
Level Two:
Cortisone can be used to decrease swelling around the affected tendons. Cortisone can be given either through supervised therapy, using a technique called iontophoresis, or through direct injection. Iontophoresis uses electric current to drive a cortisone cream into the deeper tissues. It is usually painless, and requires 4 to 6 treatments to be effective. The injection is done in an office setting, in conjunction with local anesthetic. Risks of a cortisone shot include small risks of infection or allergic reaction. Cortisone injections rarely cause whitening or depigmentation of a patch of skin, or loss of some of the soft tissue under the skin called subcutaneous atrophy. Level one treatment should be continued for at least 3 weeks after an injection. Up to 3 injections can be given.
Level Three:
Surgery can be done when symptoms do not respond to the above levels. Surgery is done to release the tight compartment that the tendons travel through. It is done as an outpatient procedure, under local anesthesia or regional block anesthesia. It is usually very effective, and recurrence is rare. Risks of surgery include a risk of infection, nerve damage, painful scar, or persistent pain. A splint is worn after surgery full time for two weeks, and then gradually weaned over the next 2 to 4 weeks. Formal therapy is usually not needed after surgery.
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