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De Quervain's disease.

De quervain

1. It is  an inflammation of the girdle surrounding the tendons of the long abductor and the short chest expander of the thumb (ténosynovitis ) which walk both in the same fibrous tunnel, in the external edge of the wrist, in the contact of the radius. The irritation often begins on the occasion of a change of activity, a shock or an unusual use. It speaks then by the frictions of the tendons which become nodulaires and increase in volume in their girdle which is unstretchable.

de quervain2

de quervain

2. The affection is translated by an  pain, in the external edge of the wrist, aggravated by the movements of the thumb. A painful, visible and tangible nodule, trained by thickenings of the fibers of the tunnel and the tissue which recovers tendons, can exist. The local infiltrations of cortisone, anti-inflammatory drugs and the splints  often have a favorable but sometimes temporary effect. In case of obstinacy of the pains and the escalation of the functional embarrassment, it is reasonable to operate.

Finkelstein's test

de quervain

 3. The intervention is mostly made under local anesthetic, in ambulatory surgery (1day). It consists, by a small incision, in opening the girdle which trainsforms a real tunnel. To enlarge it allows to reduce the frictions between tendons and girdle, source of pains. Tendons find then spontaneously their normal calibre. The manual activity is prematurely authorized without particular limitation, very often after the bearing of an orthosis a few days, but it will be necessary to avoid wetting the hand before 8/10 days. The reeducation is optional.

 

Operating view

4. The complications remain rare if the intervention is realized by a pulled surgeon:

  • the infection is rare;
  • a sensitive scar, itches in the back of the hand or the fingers are possible and can persist sometimes for a long time.
  • a swollen, painful hand, with a perspiration then steepness evokes an DSR.
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