Surgery for de Quervain's Disease

De Quervain's disease, also known as de Quervain's tenosynovitis, is a condition that affects the tendons on the thumb side of your wrist. It occurs when the tendons around the base of the thumb are irritated or constricted, leading to pain and tenderness. In some cases, surgery may be necessary to treat de Quervain's disease.

Indications for Surgery

Surgery is usually considered for patients with de Quervain's disease who have not responded to conservative treatments such as physical therapy, bracing, or corticosteroid injections. The main indications for surgery are:

• Persistent pain and stiffness in the wrist and thumb
• Difficulty performing daily activities due to pain and limited mobility
• No improvement with conservative treatments
• Presence of a ganglion cyst or other complications

Surgical Procedure

The surgical procedure for de Quervain's disease is called a de Quervain's release. The goal of the surgery is to relieve pressure on the tendons by releasing the constricted tissue and allowing the tendons to move freely.

The procedure typically involves:

1. A small incision (about 1-2 cm) is made on the thumb side of the wrist
2. The surgeon identifies the affected tendons and releases the constricted tissue
3. The tendon sheath is opened to allow the tendons to move freely
4. Any inflamed or damaged tissue is removed
5. The incision is closed with sutures or staples

Types of Surgery

There are two main types of surgery for de Quervain's disease:

• Open release: This is the traditional method, where a small incision is made to access the affected tendons.
• Endoscopic release: This is a minimally invasive procedure, where a small camera and instruments are inserted through tiny incisions to release the constricted tissue.

Risks and Complications

As with any surgical procedure, there are risks and complications associated with de Quervain's release surgery. These include:

• Infection
• Bleeding or hematoma
• Nerve damage
• Tendon rupture
• Scarring or keloid formation
• Persistent pain or stiffness

Recovery and Rehabilitation

After surgery, the wrist is typically immobilized in a splint or cast for several weeks to allow the tendons to heal. A rehabilitation program is then started to regain strength, flexibility, and range of motion.

The recovery process usually involves:

1. Pain management with medication and ice
2. Wound care and dressing changes
3. Gradual mobilization of the wrist and thumb
4. Strengthening exercises to improve grip strength
5. Range-of-motion exercises to improve flexibility

Outcomes and Prognosis

The outcome of de Quervain's release surgery is generally good, with most patients experiencing significant improvement in pain and function. However, the success of the procedure depends on various factors, including:

• Severity of the condition
• Presence of any underlying conditions
• Adherence to post-operative rehabilitation program

With proper treatment and rehabilitation, most patients can expect to return to their normal activities within several weeks to months after surgery.