surgery of tenosynovialitis de Quervain

When is a surgical treatment necessary? 

A surgical treatment of te de Quervain disease (tenosynovialitis) at the wrist is necessary if:

The conservatice therapy did not provide the expected result over weeks or even month
If the symptoms are very severe and a severe swelling of the 1. extension comardment occurs in early stages of the disease

a patient has an abnormal tendons in the area of the 1. Extensor tendon section, as they react negatively to every conservative therapy.

Can it ever be too late for a surgery?

No! The de Quervain disease is a benign, non-infectious inflammation of the tendon sheats. Before deciding to undergo a surgery or not, all other treatments can be performed without pressure in a timely manner.

This also applies for alternate treatment like e.g. the therapy of tenosynovialitis with a low level laser.

Is it necessary to perform a MRI (magnetic resonance imaging) before a surgery?

No. This is only necessary in severe cases.

The illustration shows such a case. Here, a tumour is within the surgical area.

If other disease are nearby in addition, like an arthrosis at the thumb basal joint or similar variations occur, a ultra sonic or an x-ray examination could be necessary.

What is basically done during the surgery?

During the surgery, the 1. extensor tendon section is split.

In advanced cases, a removal of the inflamed tendon sheats is necessary as well as the separation of tendon adhesions.

The band between the red arrows is split during the surgery.

Where is the incision conducted during the surgery?

With the surgery, an angular incision is made above the 1. stretch tendon section (illustration) (black line).

Alternatively, a small, transversal incision is possible!

The fat layer is dissected aside and in the depth, the (narrowed) 1. stretch tendon section is featured.

Then, the 1. stretch tendon section is split completely. The hereby expanded tendon canal lets the stretch tendons now glide without hindering.

The surgery is finished with skin suture and dressing after stopping the bleeding. Some surgeons apply a splint for a couple of days. (that reduces the pain in the phase directly after the surgery!)

Is the surgery performed outpatient ?

Usually, the surgery is performed in an outpatient manner. Only with problematic general illnesses or if sufficient home care can not be provided, treatment in a  hospital needs to be considered.