De Quervain’s disease
De Quervain’s disease, also called first dorsal compartment tenosynovitis, is an inflammation around the tendons that straighten the thumb, which causes pain.
Resting the thumb tendons is essential and applying ice, elevation and non-steroidal gels topically occasionally works in addition. However, ensuring strict rest is difficult to achieve without the use of a splint which immobilises the thumb and sometimes a splint cannot be worn in certain jobs. If this does not work, a steroid injection can help calm down the inflammatory process enough to fully recover. When this fails, surgical release of the tight tunnel under which the tendons are becoming inflamed, alleviates symptoms.
Resting the thumb in a splint usually requires 4-6 weeks for a significant improvement to be noted and the full effect will be evident by eight weeks. Steroid injections are usually painful for 1-2 days and then take approximately six weeks to take full effect. The results of steroid injections can be permanent although most are temporary (lasting 6-9 months) or cause some of the symptoms to remain, if they are severe. In these cases, the steroid injection can be repeated. If the steroid injection fails, or an immediate solution is required, surgical alternatives, will be explored if appropriate.
There is a small theoretical risk of an allergic reaction to the steroid injection, if a person has not had these injections before. The injection sites occasionally bruise and can swell. Infection is a small risk and like with any injection would be treated with antibiotics. When injecting around the tendons, infection may require an emergency operation, but this is extremely rare. Surgical release leaves a scar on the hand, but these usually heal very well. Like with all other surgery, bleeding is also a theoretical risk. Tender scar tissue occasionally takes a few months to settle down with massage. The condition rarely recurs.
The success rates from using a splint are approximately 50%, with a steroid injection this increases to 75%. Surgical release results in almost complete elimination of any pain.
The indicative prices below include the surgical fee, any anaesthetic used and the associated fees from the consultant administering this, in addition to the hospital fee and all tests and follow up. An accurate breakdown and a detailed quote will be given following the initial consultation.
From £250 for a steroid injection under local anaesthetic
From £3,500 for surgical release under general anaesthetic
Following any injections or surgery on the hand, swelling and discomfort is inevitable. Elevation of the affected arm and non-steroidal anti-inflammatory medication helps. Early immobilisation for 48 hours helps recovery but must be followed by appropriately gauged mobilisation. Simple pain relief (paracetamol and/or ibuprofen) taken one hour before hand therapy rehabilitation allows more exercises to be undertaken. Desensitisation with moisturiser and massage helps scars to soften and become less painful.
- Surgery duration: 1 hour
- Type of anaesthesia: Usually general anaesthetic
- Time in hospital: Day case
- Time off work: 1 week
- Recovery time: 2 weeks
- First follow up appointment: 1 week
- Total number of follow up appointments: 3
- Pain management: Simple pain relief (paracetamol and/or ibuprofen)
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