Why Choose Cedars-Sinai Marina del Rey Hospital for de Quervain’s Disease Treatment?
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 Procedures Performed at Cedars-Sinai Marina del Rey Hospital for de Quervain’s Disease
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.
Drugs and Other Treatments Needed for de Quervain’s Disease
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.
Symptoms of de Quervain’s 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.
Diagnosis of de Quervain’s Disease
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.
Risk Factors for de Quervain’s Disease
The risk factors that contribute to the development of de Quervain’s disease include:
- Advancing age: The risk of de Quervain’s disease is greater as a person gets older. People ages 40 to 50 are at a higher risk of developing de Quervain’s disease.
- Gender: Women are eight to ten times more likely to be affected by de Quervain’s disease than men.
- Pregnancy: Pregnant women are more likely to develop this condition than women who aren't pregnant.
- Occupation or hobbies: People who have jobs or hobbies that require repeated hand and wrist movements are more likely to develop de Quervain’s disease.
Causes of de Quervain’s Disease
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:
- Acupuncture: Several studies, conducted by the National Center for Complementary and Alternative Medicine (NCCAM), have proved that acupuncture is effective in the treatment of pain related to overuse injuries.
- Massage therapy: Massage is known to increase the blood circulation, to improve the range of motion in the thumb and wrist, and to help break down scar tissue that may lead to pain and numbness.
- Transcutaneous electrical nerve stimulation (TENS): TENS therapy involves the use of a patient-controlled portable tool that sends mild electrical impulses towards the injured tissues using skin-attached electrodes. As many as 75- to 80-percent of patients with pain related to overuse injury have found this therapy to be useful.
De Quervain’s disease can be prevented by taking certain precautions that include:
- Resting the arm at frequent intervals while performing tasks that involve repetitive movements.
- Adopting proper ergonomic postures in the workplace.
- Avoiding activities that cause pain and swelling in the wrist and thumb.
- Avoiding repeated keystrokes using the same thumb.
- Performing regular stretching and strengthening exercises that involve the hands and wrists.
- Using a brace or splint if recommended by your doctor.
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.