What results can be expected after the surgery of a de Quervain disease (Tendovaginitis)?
In the vast majority of the cases, the severe pain at the narrowed place at the forearm is removed after the surgery. Also the limited strength is improving with a few month.
Can pain remain after the surgery even after uneventful surgeries?
Yes. This is even possible with uneventful surgeries. Causes can be:
● an accompanying arthrosis at the thum basal joint (to be seen in the x-ray image)
● A non-split, additional section (compartement) within the tendon canal
For the last mentioned issue, some explanation is necessary:
In the tendon canal (1. extensor tendon section) 2 extensor tendons for the thumb can be found. Some people have 3 extensor tendons at this location and sometimes one of those tendons lead to a sub canal, in addition to the main canal. (Isolated compartement for the short thumb extensor).
This isolated tendon compartement can be narrowed and should be split during the primary surgery. Refraining this measure can be the cause for the remaining pain.
What are the risks of the surgery?
In most of the cases, the surgery is with less complications. Nevertheless: No surgery without possible complications. In the following, some (but not all !) surgical risks are described exemplary:
The red arrow in the illustration marks the point, where the incision is performed. The blue arrow show the course of the spoke bone nerves in the surgical area.
The illustration shows how close the nerve tracks (in the illustration: yellow) are to the tendon canal, which needs to be split. Even if rare, severance or contusion of the spoke bone nerve or of one of its nerve branches can occur.
The nerve can be damaged directly by the scalpel, indirectly by hook pressure, swelling or during electric coagulation of blood vessels!
This then leads to a numb feeling on the spoke’s side of the forearm and at the extensor side thumb.
Mostly an unpleasant, “electrifying” pain occures at the point of injury occurs after few days. (A neuroma)
The discomforts after damaging the radial nerv can be very disturbing and remain under unfavorable circumstances.
Rarely, severy infections or serious movement disorders (CRPS,)
The illustration shows an acute stage of a CRPS (chronic regional pain Syndrom) with massive swelling and painful movement disorders.
Need an infection or healing disorder to be considered as complications after the surgery of a de Quervain disease?
Also if infections or healing disorders are rare conditions after this surgery, the complication should be considered, if the course of the pain differs from a usual follow-up case.
The surgery related pain subsides after few days after surgery. The range of movement of the thumb and the wrist is improving and night’s rest is not disturbed by pain in the hand.
If, after days of significant improvement, pain re-occurs and additionally the range of movement is worsening, the wound should be inspected by an experienced hand surgeon.
Especially if the wound is redenning and swelling, the possibility of an infection needs to be considered. If this suspicion is re-inforced, the wound needs to be opened immediately. A new surgery should not be delayed in case of a deep infection.
With superficial disorders of the wound healing it’s enough to remove some sutures early and to give the secretion a possibility to drain. (Eventually, the prescription of antibiotics is useful)
Is the scar painful after the surgery?
You should always consider, that scars on the hand are sensitive for a longer time compared to other parts of the body. Excessive (keloidal) scars are rare.
Superficial nerve tracks of the radial nerv lead below the scar after a surgery of a de Quervain disease. That is what often makes this scar touch- and pressure-sensitive for a longer period of time.
Is secondary bleeding after the surgery possible?
Yes, but this surgical risk is rare. At risk are especially persons taking medication affecting blood clotting. Please inform you surgeon accordingly!