DE QUERVAIN TENOSYNOVITIS

(COMPRESSION OF THUMB TENDON)

EMG(electromyography) and nerve conduction tests support the diagnosis and helpful for follow ups.

In early cases, avoiding from minor, repetetive traumas, correcting positions of elbow (if needed using splints) may alleviate the symptoms. If problems persist longer than 2-3 months and affect the life quality, surgery is the treatment of choice. Mostly axillary block anesthesia(anesthesia of the arm only) is preferred to prepare the patient for surgery. At the surgery, ulnar nerve is transposed anteriorly like a sling to minimize bending, stretching etc… of it. Symptoms may need several weeks to disappear. In late cases, motor functions may not be gained back even after nerve surgery. Tendon transfer is an alternative for patients whose surgery is failed in gaining motor functions or late primary cases. Physiotherapy is needed in some cases after surgery.

Hand splints that help to avoid painful movements of the thumb are useful in the beginning period(figure 2).Non-steroid antiinflammatory drugs are used at the same time. If symptoms persist or get worse the tunnel which compresses the tendons should be opened surgically. This surgery may be performed under local anesthesia. Some patients may have individual tunnels around each tendon and all of these tunnels should be opened carefully for a definitive pain relief. All movements are allowed after surgery without any limitation. Some patients may need physiotherapy.