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What is de Quervain Syndrome?

De Quervain syndrome is a painful condition of the wrist, due to inflammation of some of the thumb tendons as they pass through a ligament tunnel. While its exact cause is often unclear, it is commonly observed in mothers of small babies, possibly due to hormonal changes post-pregnancy or repetitive lifting of the baby. Although there is limited evidence linking it to specific work activities, pain associated with de Quervain syndrome can be exacerbated by hand use at work, home, during gardening, or while engaging in sports.

Symptoms of de Quervain syndrome include:

  • Pain on the thumb side of the wrist, particularly aggravated by movements such as lifting the thumb (e.g., in the hitchhiker position) or using scissors.
  • Tenderness and/or swelling over the thumb border of the wrist, matching the site of thumb motion related pain.
  • Occasionally, clicking or snapping of the tendons may occur.

While de Quervain syndrome is not inherently harmful, it can cause significant pain and discomfort.

How is de Quervain syndrome treated?

Not all cases of de Quervain syndrome necessitate surgery. Mild cases may resolve within a few weeks without intervention. Treatment options include:

  1. Activity modification, avoiding activities that trigger pain whenever feasible.
  2. Immobilizing the wrist and thumb with a splint, which can be obtained from a sports shop or physiotherapist.
  3. Steroid injections relieve pain in approximately 70% of cases. These can be placed by your doctor or under ultrasound guidance. They are generally very safe but there are some potential side effects that should be discussed with the administering doctor prior to injection.
  4. Surgical release is reserved for patients who have unsuccessfully attempted other treatment options, although it may be an appropriate initial approach for select patients. The operation is a small procedure which can be performed under local anaesthetic, or general anaesthetic as patient needs indicate.

What outcomes can I expect from surgery?

De Quervain surgery is a relatively small operation performed as a day case. It is a well known operation with good outcomes. However, it can uncommonly be complicated by infection, bleeding, or recurrence of de Quervain symptoms. The surgery should be performed by an experienced and well trained surgeon to avoid problems with tendon instability following surgery, or injury to nearby nerves.

What questions should I ask my plastic surgeon about de Quervain surgery?

  • Are you vocationally registered with the Medical Council of New Zealand as a specialist plastic surgeon?

  • Are you a member of the New Zealand Association of Plastic Surgeons?

  • Will the procedure be conducted in a hospital or office-based setting, and is the facility accredited for this type of surgery?

  • What type of anaesthesia is needed for this procedure?

  • Based on my medical history and condition, is surgery the best option for me? If so, am I a suitable candidate for this surgery?

  • Which surgical technique do you recommend for my case, and why?

  • What are the realistic expectations for the outcome of this procedure in my case?

  • What steps or lifestyle changes are necessary for me to get the best result from my surgery?

  • What is the anticipated duration of recovery, and what assistance will I need during this period?

  • What potential risks and complications are associated with this procedure? How would you manage these should they arise?

  • How will my results change over time?

  • If I’m unhappy with the outcome, what recourse options are available?

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