De Quervain's tenosynovitis is irritation of two thumb tendons (APL and EPB) as they pass through a tight tunnel on the thumb side of the wrist, called the first dorsal compartment. Gripping, pinching and lifting hurt, and it can be especially hard for new parents caring for a baby. Most cases are treated first with a thumb splint, activity changes and a corticosteroid injection. A De Quervain's release is the surgery that opens that tunnel.
Warning signs
- Pain that has not settled after 6 to 12 weeks of thumb splinting and activity changes
- Pain that returns within 3 to 6 months of an injection, or after 1 to 2 injections
- Pain that makes it hard to lift or care for a baby
- Thumb-side wrist pain that interferes with daily tasks
Treatment
Through a small 1.5 to 2 cm incision in a skin crease, Dr. Loredo first finds and protects the branches of the superficial radial nerve, then opens the tunnel and releases every sub-sheath so both tendons glide freely. You stay awake under local anesthesia only, so you can move your thumb at the end to confirm the release, and there is no sedation, fasting or driver needed. Most patients return to desk work in 2 to 5 days and to most activity in 2 to 4 weeks; heavy gripping usually waits 4 to 6 weeks.
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Questions patients ask
What is a De Quervain's release?
De Quervain's tenosynovitis is irritation of two thumb tendons (APL and EPB) as they pass through a tight tunnel on the thumb side of the wrist, called the first dorsal compartment. Gripping, pinching and lifting hurt, and it can be especially hard for new parents caring for a baby. Most cases are treated first with a thumb splint, activity changes and a corticosteroid injection. A De Quervain's release is the surgery that opens that tunnel.
When is De Quervain's release usually considered?
Pain that has not settled after 6 to 12 weeks of thumb splinting and activity changes. Pain that returns within 3 to 6 months of an injection, or after 1 to 2 injections. Pain that makes it hard to lift or care for a baby. Thumb-side wrist pain that interferes with daily tasks.
What is recovery like after De Quervain's release?
Through a small 1.5 to 2 cm incision in a skin crease, Dr. Loredo first finds and protects the branches of the superficial radial nerve, then opens the tunnel and releases every sub-sheath so both tendons glide freely. You stay awake under local anesthesia only, so you can move your thumb at the end to confirm the release, and there is no sedation, fasting or driver needed. Most patients return to desk work in 2 to 5 days and to most activity in 2 to 4 weeks; heavy gripping usually waits 4 to 6 weeks.
Who performs De Quervain's release near Southlake and Dallas-Fort Worth?
Dr. Pedro Loredo, a board-certified hand surgeon (General Surgery, American Board of Surgery; Hand Surgery, American Board of Plastic Surgery) at Loredo Hand Care Institute, 431 E State Hwy 114, Suite 380, Southlake, TX. New patients are seen within days. Call (972) 939-4974. Se habla español.
En español: ¿Dolor de muñeca del lado del pulgar que siempre regresa?
La tenosinovitis de De Quervain es la irritación de dos tendones del pulgar (APL y EPB) al pasar por un túnel estrecho del lado del pulgar de la muñeca, llamado primer compartimento dorsal. Duele al agarrar, al pellizcar y al levantar cosas, y puede ser muy difícil para los papás que cuidan a un bebé. La mayoría de los casos se trata primero con una férula para el pulgar, cambios de actividad y una inyección de corticosteroide. La liberación de De Quervain es la cirugía que abre ese túnel.
Señales de alerta
- Dolor que no mejora después de 6 a 12 semanas de férula y cambios de actividad
- Dolor que regresa dentro de 3 a 6 meses de una inyección, o después de 1 a 2 inyecciones
- Dolor que le dificulta cargar o cuidar a un bebé
- Dolor de muñeca del lado del pulgar que interfiere con las tareas diarias
Tratamiento
Por una incisión pequeña de 1.5 a 2 cm en un pliegue de la piel, el Dr. Loredo primero localiza y protege las ramas del nervio radial superficial, después abre el túnel y libera cada subcompartimento para que ambos tendones se deslicen libremente. Usted permanece despierto, solo con anestesia local, así que puede mover el pulgar al final para confirmar la liberación, y no necesita sedación, ayuno ni quien lo lleve. La mayoría vuelve al trabajo de escritorio en 2 a 5 días y a casi todas sus actividades en 2 a 4 semanas; agarrar con mucha fuerza suele esperar de 4 a 6 semanas.
If this sounds like your hand
Call Loredo Hand Care Institute or start your forms online. New patients are seen within days; surgery, when needed, is scheduled at the first available opening. Se habla español.