De Quervain’s Syndrome

Named after the Swiss Surgeon De Quervain who originally described this painful condition as ‘washerwoman’s sprain’ and by described rather unflatteringly by Finkelstein as a condition affecting the ‘labouring classes’!

De Quervain’s syndrome is characterised by pain and swelling on the radial aspect of the wrist with painful thumb movements and weakness in grip. There is a fairly strongassociation with pregnancy and the post-partum period – it is likely that this is due to hormonal and fluid changes.

The pain results from degenerative changes affecting the strap like tunnel around the tendons on the radial aspect of the wrist. The tunnel narrows and constricts (hence the condition is sometimes called stenosing tenosynovitis) and as a result the tendons fail to glide normally resulting in pain and swelling.

Treatment

Mild cases may settle without any treatment. Sometimes a splint will suffice. In the more symptomatic, a steroid injection into the painful area will have a 70-80% success rate. The side effect of steroids are depigmentation and skin changes which your surgeon will discuss with you.

Surgical decompression of the tunnel (s) around the tendons is offered in when symptoms do not settle. This is performed under regional or general anaesthesia, via a tranverse incision under loupe magnification protecting the nerve branches. The sheath surrounding the tendons to released so that the tendons can glide freely. Your surgeon will discuss this with you in greater detail.