De Quervain’s Tenosynovitis Surgery in Ankara, Turkey

De Quervain’s tenosynovitis surgery is performed to relieve pain and restricted movement that develop due to narrowing in the first dorsal compartment where the tendons at the base of the thumb are located. In cases that do not respond to conservative treatments, surgery offers a permanent solution.

Preoperative symptoms include pain on the thumb side, swelling, and difficulty gripping. The diagnosis is supported by the Finkelstein test on physical examination. Steroid injections, splinting, and medication are first-line approaches; however, surgery is planned for resistant cases.

De Quervain surgery is performed under local anesthesia. The extensor retinaculum, which forms the tunnel through which the tendons pass, is released. This allows the tendons to move freely. Protecting the nerve structures is of great importance while opening the compartment.

In the postoperative period, early movement is recommended and the risk of complications is low. The patient can usually return to daily life within a few days. Full recovery may take a few weeks and the success rate is high. Recurrence is rare, and surgery generally provides lasting relief.

What Is De Quervain’s Tenosynovitis Surgery?

De Quervain’s tenosynovitis surgery is a surgical procedure performed to relieve pain and restricted movement caused by thickening of the sheath surrounding the thumb tendons. It is preferred when conservative treatments do not provide relief. During the operation, the narrowed tendon sheath is released so that the tendons can move freely. It is usually performed under local anesthesia, and patients can return to daily activities in a short time.

What is De Quervain’s tenosynovitis and why does this painful condition occur?

To understand this condition, we first need to visualize how the remarkable anatomy in that part of our wrist works. On the thumb side of the wrist, there is a tunnel-like structure about 1 centimeter long, which we call the “first dorsal compartment.” You can think of this tunnel like the strap of a watch on your wrist; it is a strong fibrous layer that covers the bones. Two important tendons that allow us to lift the thumb upward and move it outward pass through this tunnel. In a healthy wrist, the inside of this tunnel is extremely slick, and the tendons glide smoothly within it as if lubricated.

However, things do not always go smoothly. In De Quervain’s tenosynovitis, rather than classic inflammation, structural degeneration occurs in the tissue. With overuse, strain, or hormonal effects, the sheath over the tendons and the walls of the tunnel begin to thicken. Just like skin that becomes calloused, that delicate, slick tissue is replaced by coarse and thick tissue. As the tunnel walls thicken, the space inside narrows. At the same time, the tendons also swell due to edema.

As a result, a true mechanical mismatch occurs. Thickened tendons become trapped as they try to pass through the narrowed tunnel. With every movement, every time you lift your thumb, friction occurs. This friction leads to more edema, and more edema leads to more entrapment. The severe pain you feel is the result of this mechanical friction and compression. Sometimes you may even feel a “creaking” sound or vibration when you place your hand over that area of your wrist and move your thumb.

What are the symptoms and how does De Quervain’s tenosynovitis present?

The condition usually starts insidiously, but after a point it can turn life into a nightmare. The most typical symptom is pain felt just above the bony prominence on the thumb side of the wrist (the radial styloid). This pain may sometimes radiate toward the tip of the thumb, and sometimes shoot into the forearm.

The complaints we most frequently encounter are:

• Difficulty opening jar lids
• Pain when turning a key
• Inability to wring a towel or cloth
• Stinging pain in the wrist when lifting a baby
• Quick fatigue while writing
• A catching sensation during thumb movements

To make the diagnosis, we do not actually need very complex devices. The “Finkelstein Test,” which you can also try very carefully at home, is the gold standard for us. To perform this test, tuck your thumb into your palm and make a fist by closing your other fingers over it. Then gently bend your wrist downward toward the side of your little finger. If you feel a sharp pain on the thumb side of your wrist during this movement, the test is positive and the diagnosis is most likely De Quervain’s tenosynovitis.

Who is at risk and in whom is De Quervain’s tenosynovitis most commonly seen?

Although this condition can be seen in all segments of society, statistics show us a very clear target group. The disease most commonly occurs in individuals between 30 and 50 years of age. The incidence in women is significantly higher than in men.

The most important risk groups are:

• New mothers
• Women in the last months of pregnancy
• Breastfeeding mothers
• Grandmothers involved in baby care
• Office workers who use computers intensively
• Pianists
• People who do gardening
• Carpenters

The “new mother” group is especially important for us. Hormonal changes during pregnancy and breastfeeding cause the body to retain water and tissues to swell. When you add to this the constant positioning of the thumb in a strained posture while breastfeeding or carrying the baby, the tendons give out. In the literature, you may also hear this referred to as “baby wrist” or “mommy thumb.” For these mothers, baby care becomes more difficult, and the pain they experience makes the postpartum period even more challenging.

Which treatment methods can be applied before surgery?

As a Plastic and Aesthetic Surgery specialist, we do not prefer to take every patient who walks in the door directly to surgery. If the condition has not become too chronic and there is no locking of the tendons, we first try non-surgical methods. The body’s potential to heal itself deserves a chance.

Conservative treatment options include:

• Thumb-support wrist splints
• Anti-edema medications
• Ice massage applications
• Activity modification
• Corticosteroid injections

Here I would like to open a separate parenthesis for corticosteroid, meaning cortisone injections. These injections are powerful tools to resolve edema and thickening in the tendon sheath. When performed correctly, they can completely eliminate complaints in a large proportion of patients. However, from an aesthetic surgeon’s perspective, these injections have some risks. Cortisone can cause fat atrophy under the skin and skin color changes (whitening). In a very visible area like the wrist, this can be aesthetically bothersome. Therefore, the injection must be given very deeply, precisely into the tendon sheath. We usually prefer to perform it under ultrasound guidance. And as a principle, we try it once or at most twice. If the pain does not resolve or recurs despite two injections, there is no point in insisting; surgery becomes inevitable.

What is the surgical process like and what is the Plastic Surgery approach?

De Quervain surgery is a comfortable process for our patients and not a frightening one. It usually does not require hospitalization and is performed as an outpatient procedure.

The characteristics of the surgery are:

• It is performed under local anesthesia
• General anesthesia is not required
• The procedure takes about 30 minutes on average
• No hospital stay is required
• You go home the same day

At the start of surgery, we apply a tourniquet to the arm. This tightens the arm like a blood pressure cuff and temporarily stops blood flow. The reason we do this is to work in a “bloodless field.” Because there are millimetric nerve branches in the area, and even the slightest bleeding can obscure our view.

In line with plastic surgery principles, we are very meticulous when planning the incision (cut). We usually make a transverse incision parallel to the wrist creases. Thus, when it heals, the scar blends into the natural skin folds and becomes almost invisible. Alternatively, zig-zag or “S”-shaped incisions may be preferred to reduce skin tension.

After passing through the skin, the most critical stage begins: protecting the “superficial branch of the radial nerve.” This nerve provides sensation to the back of the hand and the thumb. It is very thin and can run in a different location in each patient. In surgery, we usually use magnifying loupes to find these nerve branches and gently retract them. If this nerve is cut or compressed without being seen, permanent numbness or painful neuromas may occur after surgery. Therefore, this stage is not rushed.

After the nerve is secured, the roof of the tendon sheath is opened. The tendons are released. At this point, we обязательно search for the septum mentioned above. If present, it is also released. Because we can talk to the patient on the operating table (since only the wrist is numbed), we ask the patient to move the thumb. We see with our own eyes that the tendons glide smoothly and do not catch anywhere. This is what we call an “intraoperative test,” and it is the guarantee of success.

What should be considered during the postoperative recovery period?

The surgery is over and you have returned home. Now it is time to recover. Many of our patients think they should not move their hands at all right after surgery. This is completely wrong. On the contrary, we want you to start moving your fingers the next day.

Important steps in the recovery process are:

• Keeping the hand elevated for the first 48 hours
• Regular ice application
• Using simple painkillers
• Early finger movements
• Avoiding contact of the wound site with water

Why is early movement so important? Because we opened the tunnel and released the tendons. If you do not move, healing tissue can adhere to the tendons and restricted movement can develop again. Therefore, we encourage you to gently move your thumb within the limits of pain.

Stitches are usually removed between 10 and 14 days. If we used aesthetic, self-dissolving sutures, there may be no need to remove them at all. After the stitches are removed, scar care begins. With silicone gels and massages, we prevent the scar from becoming raised and red. After about 3–4 weeks, our patients can fully return to daily life. In those who do heavy work, this period may extend to 6 weeks.

What are the possible complications and risks?

Every surgical procedure, no matter how small, carries some risks. Discussing this openly with our patients is the foundation of trust.

Possible issues we may encounter include:

• Radial nerve sensitivity
• Infection at the wound site
• Recurrence of the condition
• Slipping of the tendons out of place
• Formation of a painful scar

The most feared complication here is nerve injury. Damage to the nerve may cause numbness on the back of the hand or a sensation like an electric shock. However, in expert hands, with microsurgical principles and under magnification, this risk is extremely low. Recurrence, as we said, is usually related to incomplete release or missing the septum. With the correct technique, the success rate of this surgery is close to 100%.

Another rare condition is “tendon subluxation.” If we open the tunnel too much, the tendons may pop forward when you bend your wrist. To prevent this, technical nuances come into play, such as not opening the entire tunnel but only the part causing entrapment, or performing surgery while preserving a portion of the tunnel.