Most individuals working regularly on computer keyboards or using power tools which produces strong vibrations, complain of pain over the outer aspect of the wrist and particularly over the base of the thumb.
This is usually mild but sometimes, patient complain of severe incapacitating pain which gets aggravated with gripping movements or even holding a pen.
One of the important reasons for such pain is DeQuervain's disease. It involves tenosynovitis (inflammation of tendon sheaths) of the tendons lying at the base of thumb on the back of wrist.
The inflammation causes a constriction in the tendon sheath, and interferes with the smooth excursion of tendon within its sheath.
It is more commonly seen in association with Diabetes Mellitus, Rheumatoid Arthritis or Hypothyroidism. Patients presenting with this disorder are usually the working population with high demands and work pressure.
The treatment of DeQuervain's disease is usually conservative.The patients is started on anti-inflammatory medications; and Ultrasonic therapy of the tendon sheath. Most patients do fairly well with this therapy. Usually a short course of 5 to 7 sittings is required.
In patients, not responding to above treatment, the tendon sheath can be infiltrated with locally acting steroid. This does not produce any systemic side effect. However, the treatment success results are 60 - 80 percent.
In patients who fail to respond to a course of anti-inflammatory medications/ physiotherapy or injections, they fall into the category of cases requiring surgical intervention.
Surgery is effective way to treat resistant cases. The tendon sheath is opened through an incision at the base of thumb on the back of wrist. Important step during surgery is to isolate and protect the Superficial Radial Nerve which provides sensory inputs to the back of hand. If the nerve is accidentally cut, it may produce an embarrassingly painful neuroma.
To conclude, most patients may be managed with conservative or minimally invasive therapies. Surgery, however is the last resort providing effective, short, daycare cure.
