KEMBLE WANG - Upper Limb & Trauma Surgeon
MBBS (Hons), FRACS, FAOrthA
De Quervain's Tenosynovitis release
You have just undergone surgical release for de Quervain's tenosynovitis with Kemble. This can be a very painful and debilitating condition arising from inflammation of the tendon that leads to the base of the thumb. Kemble has opened the tendon "compartment" that encases these inflamed tendons, allowing them to glide more freely, whilst maintaining their stability.
The following is a diagram of the tendons that are involved in de Quervain's.
Post operative recovery
Your wrist and thumb will be supported by a forearm-based splint that extends to your thumb – a thumb-spica splint. You may have some numbness or tingling on the side of your hand near your thumb and index finger from the local anaesthetic used to help you with any post-operative pain (this should wear off within about 24 hours).
While significant swelling is not anticipated following this procedure, it would be helpful to keep your hand/wrist elevated as best you can for the first 24 hours after surgery. You can also apply an icepack or frozen vegetables to the thumb side the dressing at the level of your wrist to help keep swelling to a minimum. To help your recovery, keep your fingers moving. Make sure you can make a fist with your fingers and completely straighten them. Your thumb and wrist will be immobilised, and you should not move them. Repeat these motions and efforts throughout the day, especially in the first few days following surgery to keep internal scarring from becoming an issue.
The splint is intended to stay on until your first post-operative visit. At that time, we will remove it to examine the wound. Once the surgical dressing is removed, and you are fitted with a splint, keep the wound and your skin clean. Soap and water are an excellent skin cleanser, and it is OK to get everything wet in a shower with running water. The thermoplastic splint you will be fitted with at your first post op visit is intended to stay on for 80% of the time. You may remove it for exercises and when resting, but have it on the remainder of the time to help rest the tendons while they heal.
The hand therapist will provide you with tendon glide exercises starting at the first post op visit. These will involve gentle wrist and thumb stretches to help the tendons stay mobile whilst preventing over-exertion and recurrence of the inflammation. You should avoid using your hand to lift anything heavier than a coffee mug for the first 6 weeks post op. When exercising, do not push your hand past the point of pain - rather use it as a sign to indicate to you that you should limit what your wrist can tolerate at that point.