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The highly skilled plastic surgeons at Cedars-Sinai Marina del Rey Hospital are well-versed in the assessment and treatment of patients with de Quervain’s disease. There are several surgical and conservative treatment methods available. Upon having your individual case assessed and analyzed, our doctors will suggest a treatment plan to best suit your condition.
De Quervain’s disease, also referred to as the washerwoman’s sprain, is a common type of inflammation of the thumb's tendon lining (tenosynovitis) that causes swelling and creates friction inside the narrow tunnel through which these tendons pass. Patients suffering from de Quervain's experience pain that extends from the base of the thumb and up the forearm. The causes of this condition are not clear, but overusing the thumb through repetitive actions such as grasping, racquet sports, gardening, workplace tasks, and inflammatory disorders such as rheumatoid arthritis can act as triggering factors. De Quervain's can also develop in woman that are pregnant (often during the last trimester) or breastfeeding. As a result, de Quervain’s disease is eight to ten times more common in women than in men.
Surgical treatment may be recommended when the symptoms of de Quervain’s Disease are severe, or when conservative treatments are unsuccessful. The main objective of surgery is to open up the thumb compartment, or sheath, to create more space and allow the movement of the swollen tendons. The surgical release of tendons is done as an outpatient procedure, meaning the patient can return home on the same day. The operation may be performed under local or regional anesthesia. During the procedure, a portion of the tendon sheath may be excised or a step cut may be made, followed by the suturing of a strand of the sheath back over the tendons. Patients can resume normal activities once they feel comfortable using their hands.
The treatment for de Quervain’s disease aims to relieve the inflammation, to preserve normal thumb movements, and to avoid recurrences. A symptomatic relief may be expected within four to six weeks of treatment, if treatment is initiated during the early stages of the disease.
Pain and swelling at the base of the thumb are the main symptoms of de Quervain’s disease. These symptoms may start suddenly or develop over a period of time. If left untreated, the pain may extend to the wrist and forearm. Patients may also experience difficulty moving the thumb and wrist, especially while trying to grasp objects. Sometimes, a fluid-filled cyst may accompany the swelling. A "catch" or a "snap" may also be felt during thumb movements.
In order to correctly diagnose de Quervain’s disease, a doctor will perform a careful physical examination of the affected hand, during which pressure will be applied to the base of the thumb in order to check for pain. In addition, the doctor will perform a Finkelstein test, during which the patient is asked to bend the thumb over the palm, and then bend all the other fingers over the thumb. Subsequently, the patient will be told to move their wrist towards their little finger. If this maneuver elicits pain at the base of the thumb, the diagnosis of de Quervain’s disease is confirmed.
The risk factors that contribute to the development of de Quervain’s disease include:
The chronic overuse of the wrist is the main cause of de Quervain’s disease. Repeated movements of the wrist result in the irritation and inflammation of the sheath covering the tendons. Activities such as racquet sports, gardening, and other similar tasks may aggravate symptoms of de Quervain's. Other causes can include a traumatic injury to the thumb or wrist leading to the formation of scar tissue, inflammatory conditions such as rheumatoid arthritis, and pregnancy.
The following alternative therapies are considered beneficial in treating the symptoms of de Quervain’s disease:
De Quervain’s disease can be prevented by taking certain precautions that include:
Are you experiencing symptoms that resemble de Quervain’s disease? You can learn more about de Quervain’s disease by getting in touch with our skilled plastic surgeons at Cedars-Sinai Marina del Rey Hospital.
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