In the past four months, I’ve noticed a significant increase in the number of patients presenting with De Quervain’s tenosynovitis. This has made me ask ‘why?’ I believe it’s not just caused by the current backlog of patients who have delayed seeking treatment, but something else is contributing, namely, the dramatic changes to patients’ lifestyles during the pandemic. In this article, I’ve outlined what lifestyle changes could be contributing, but also a useful reminder for GPs and AHPs on how to correctly diagnose De Quervain’s and treatment options available to patients.
De Quervain’s tenosynovitis – lifestyle contributing causes
In a recent consultation with a patient, she highlighted the massive increase in video chat that she’s been doing with her sister over the past year, using her phone. This was to substitute for the lack of face-to-face contact they had during the pandemic. Prior to that, video chat wasn’t something she would normally do.
Another patient mentioned that she experiences pain when taking selfies, which she’d been doing and sharing more frequently throughout the pandemic. Again, this was to make up for lack of face-to-face time with family/friends, and also having more time on her hands to do so.
Whilst many people were on furlough and had more leisure time on their hands, the use of video games also increased, as did texting.
So, whilst video chat, selfies and gaming might not be the primary cause of De Quervain’s, it has led me to believe that they could be contributing to this painful condition, caused by patients using their phones differently and game consoles more frequently during the pandemic, resulting in the repetitive overuse of the wrist.
In the past this condition has been referred to as mother’s thumb, but in the future, who knows, it might be called ‘selfie’s thumb’ or ‘Zoom thumb’ instead!
How to diagnose De Quervain’s tenosynovitis?
It’s very simple to do using the Finkelstein Test.
How do you differentiate between De Quervain’s and Carpel Tunnel Syndrome?
Swelling in the wrist is a common symptom for both, but unlike De Quervain’s, a sensations of tingling and numbness is a distinguishing symptom in Carpel Tunnel Syndrome.
What are the non- surgical treatment options for De Quervain’s tenosynovitis?
De Quervain’s can be treated successfully, usually, without the need for surgery. I will always explore non-interventional treatments with patients first. These are hand therapy, splinting and ultra-sound guided steroid injections.
When is surgery necessary to treat De Quervain’s tenosynovitis?
Surgery is only necessary when all other non-operative measures have failed (splint, injections, etc.).
What does surgery involve?
The procedure can be done under local anaesthetics (which is the more common) or general anaesthesia.
A small cut is made transverse over the tendons, and the surrounding tunnel of tissue is identified, and then divided to free up the tendons. It takes less than 30 minutes to perform the procedure.
The skin is closed with absorbable sutures and a bandage is first applied for two days, then reduced to a simple dressing over the incision. The hand can be used normally at 10 days in activities such driving and desk work. Heavy manual work is usually ok from the 4th to 6th week.
Physiotherapy after surgery is not usually intensive and it is mainly to ensure that the wrist and tendons are being mobilised satisfactorily. A splint will NOT be generally necessary after surgery.
How much will De Quervain’s treatments cost if done privately?
My NHS patients are asking me this more frequently. Waiting lists for treatments can be as long as 3-4 months (14 months for surgery), so they are keen to know the cost of paying themselves to have the treatment done privately.
Non-surgical treatments are relatively inexpensive:
- £20-30 for a hand splint
- £50-60 per session for course of hand therapy treatments with a specialist hand therapist, with usually with a minimum of 6-8 sessions required
- £250 for an ultra-guided steroid injection (if done in clinic)
Surgery is much more expensive and would cost in the region of £1500-£2400, depending on which surgeon and which hospital.
What happens if De Quervain’s goes untreated?
If left untreated, the pain may spread further into the patient’s thumb or up the arm and the mobility of the thumb and wrist severely hindered. Doing small repetitive tasks using the wrist will become more difficult due to the pain.
Mr Daoud Makki, Consultant Upper Limb Surgeon
For more information visit, Mr Daoud Makki – London Sports Orthopaedics
To arrange an appointment: Tel: 020 7496 3552 or Email: makki.admin@sportsortho.co.uk
If you are a GP, physio/AHP and would like Mr Makki to lead a CPD session on De-Quervain’s or any other upper limb conditions, then please email: events@sportsortho.co.uk