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De Quervain's Surgery???
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De Quervain's Surgery???

I've been battling De Quervains since Nov. 2010.  I had a brace applied back in November, a cortisone shot in Jan, and another cortisone shot on March 18th.  My doc says she only does 2 shots and then its surgery.  However, since I got the shot on March 18th, I have to wait 6 weeks for surgery.  What should I expect for the surgery??  And afterwards??  Since its gonna be a local numb, would I be able to watch what the surgeon is doing?  I don't have any children or pets, but I work in medical records with a lot of repetitive motion.  Also, then tendons on the top of my wrist are starting to be affected as well.  Any advice would be greatly appreciated!
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1605619_tn?1301635451
I don't think you'll be able to watch the surgery due to the sterile field but you never know, it depends on the surgeon and the anesthesiologist.  I'm surprised that it is being done with just local.  The surgeon I worked for splinted patients after surgery and then lots of physical therapy.  I think the problems with the top of your wrist will resolve after your hand gets taken care of and is on the mend!  Best of luck!
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Avatar_m_tn
I am trying to post my experience with de Quervain on any related subject, especially when it comes to surgery. Hope this helps:

I have glanced through most forums, blogs, etc. on de Quervain and may have a few useful aspects to share. I waited to publish anything because I wanted to test everything and give it time to prove success. I have had phenomenal success with mainly some simple exercises and stretches and am functioning pretty much as I had before the onset. I will not label my success as a cure because I know this condition can come and go, but will provide updates if my path changes again. I feel a bit of background is important in case you find other insights or ideas.

I was diagnosed with de Quervain symptoms in both wrists since the summer of 2009 and had some really bad bouts of pain, burning, waking with aches, tingling in the index finger, etc. during 2009 and the summer of 2010. I immediately ran to the orthopedic clinic and was almost forced to consider surgery. I ran! It came on very sudden after a long car trip, in which I tend to extend and push my thumb on the top of the steering wheel. I also tend to push on my thumb and pinkie in locked extended position with the use of a turbo mouse. The pain got so bad I thought I was going to have to give up my work in graphic design. I have tried everything except surgery. I did one Cortizone shot and it abated the pain for about 2-3 months. Hand massage and stretching helped a little. Took some meds, mainly for the inflammation, but was not interested in masking the pain. Did a few ultrasound and infrared sessions, felt cool, but worked like the massage. Chiropractic treatments seem to be doing something, but did not take the pain away completely. Focused heavily on posture, ergonomics at work, changing habits, rest, etc. Had two free deep massage sessions on my neck on shoulders and felt great for a few days. I had full spectrum blood/systemic tests and checked for deficiencies (was a bit low in B-12 and docs asked about my diet which did not include a lot of animal protein). I looked into prolotherapy, PRP injections and acupuncture, but did not commit. Even inquired about neuromodulation, but figured I would never be a good candidate. Tried lots of different types of exercise and usually felt pretty good during a good cardio workout, probably because of good blood flow. Copied a slow hand-weight regimen I saw on YouTube. Tired my own set of isometric weight exercises (5-10 lbs. at the most), didn't help or add to the pain, interestingly. Tired 3 different types of mouse and keyboard set-ups. Bracing, tape, splints, immobilization, etc. was fine until I took off the brace off, I even tested a prototype cast from Exos Medical (I mentioned this company because I spoke briefly with their sports physiologist who told me something important that stuck in the back of my mind and will get to further in). I searched and searched for more information and never found anything useful and most was not very positive. I assume those who have found relief do not share their results for whatever reason, but I am driven to provide some insight since I know the feeling when you don't know where to turn.

In the winter of 2011 I recalled my conversation with the Exos sports physiologist, the chiropractor and the deep massage sessions. I was too focused on just my wrists, fingers and forearm and really had not tried anything in the upper body and neck. I started some simple slow motion neck movements and stretching in the shoulders, neck and arms. I am not saying this is a cure, but I have been almost pain-free, without inflammation, etc. since the early spring 2011. One hypothesis is that the condition, whether de Quervain or not, is being created by a combination of the subluxation that I have in the extremity joints and the involvement of nerves that emanate from the lower cervical (neck) region also as it all ties together with the muscles in the upper body. Whenever I take a shower I do some very simple stretches and movements and focus on my neck, upper shoulders, back, forearm and a bit on the fingers and wrists. If interested, I can try to explain the mechanics in a future post. I did not try any more upper body deep massage, but that may help and certainly can not hurt. The only other things, to which my success can be attributed, would be the additions of a complex B vitamin and more protein. I also do not try to lock my thumb in a stretched position for any long periods. There is nothing else I have changed in my lifestyle, diet, etc. And I'm sure my posture has gone back to its bad habits. The only time I feel a tinge of the pain is when under stress or have forgotten to do my stretching for a couple days or have not exercised. Otherwise the only feeling I have is some stiffness.

I do have a couple strong opinion. First, do not jump to surgery, you are your own advocate for your health and you owe it to yourself to consider all the options and test a few things. Even if you have gone through surgery and have not had complete success you can still try other options. Surgery may work and may be the end option, but found only a handful of physicians who would consider other treatments or would offer up information of success stories. Second, rest is not the answer in my case, the only time I got relief was when I was aggressively using my hand, thumb, the muscles, etc. The sports physiologist said he had seen many cases of de Quervain and nobody ever did more damage when pushing hard during exercise or doing tasks that involved grasping, pushing, etc.. A lot of his athletes would, as he put it: "stretch the hell out of those muscles and work your back and upper body as hard as you can."

I hope this provides some hope and ideas to try. I would be happy to provide more detail and hear more thoughts.
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Avatar_m_tn
Thank you for your information.I too have this and am finding it hard to find information . I would love to know your neck movements and shoulder stretching that you do. Thank you so much.
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Avatar_m_tn
Hello medforme,

Below is a regime I posted on another forum back in January and I have been pretty much pain and symptom-free since. I only feel of twinge of stiffness and slight aching when its been more than three days without doing the stretch & hold techniques.

A few of these stretch & hold techniques I picked up from the physical therapy sessions, which focused more on the fingers, wrist and forearms. Others are from sites for alleviating neck and back pain. Still others are from my own exercise stretching routine. Of course, I'm not a sports physiologist or physical therapist and I only play a doctor on TV, so there may be better methods or other regimes to better focus on the pain you are experiencing. All I know is something is working without any bracing, shots, meds, surgery, etc. I found that I had to really focus on the slight movements of the stretching and work it slowly in the early stages when I was still having inflammation, aching, clicking, sharp and dull pain. This is the order, in which I conduct the stretches and all are done standing up with good posture:

Neck rotation and hold (note: be very careful and slow doing any neck movements, it's really more of moving the neck into about the main positions and holding, not continual rotation.)

- Rotate neck into 8 main positions and hold each for 10-15 seconds.
- Sometimes I just hold to the 4 main positions (down, right side, back, left side)
- If I hit a tight spot I sometimes rotate back and forth a bit and then move on
- I also include a set where I use my hand(s) to push on the angle for the 4 main positions

Shoulder flex and shrugs:

- Move shoulders up and down
- Move shoulders forward as if you are pushing out your chest
- Move shoulder back as if you are trying to touch your two shoulder blades together
- I do this both with my arms out-stretched and folded up or bent at the elbow
- Not really a stretch, but should loosen up shoulders, arms, etc.

Arms out-stretched

- This one is a bit hard to explain and a subset of the Shoulder flex, but the only way to describe is to think of the Iron Man position when in flight
- Standing with head tilted up, arms flexed behind you and pushing chest out
- Also try to flex all fingers in the held position
- Should feel stretch in large muscles in the upper back

Arms folded behind head

- Make a fist and bend arm at elbow as far as you can go
- Pull up toward your head
- Use other arm to move held position behind your head
- Hold for 5-10 seconds
- Should feel stretch in neck and upper arm and under arm pit

Arms and hand outstretched in front

- For each hand pull or bend back hand so fingers are pointed upward (use other had to hold position)
- Out stretch both arms while holding this complete position for 5-10 seconds for each hand
- Should feel stretch in forearm, wrist area and some in the shoulder area

Thumb pull-back

- Another hard one to explain, but would be easy to show in a picture
- Put hand in front of you so you are looking at your palm
- Fingers out stretched and together and thumb pointing up
- Take other hand and grab thumb from the top
- Pull position forward to palm is facing up and hold for 5-10 seconds
- Probably important not to over stretch and hold too long
- Should feel stretch in wrist/forearm and thumb, should feel like a combo stretch
- I did my research and there are not many exercises/stretches that focus out these parts

Misc. and regular exercise stretches

- Do these if I have extra time or at random points during the day
- Touching hands to toes while alternating the wrist positions
- Turning torso left and right, looking over shoulder, hold for 5 seconds
- Interlock fingers and stretch with palms facing forward and arms out stretched
- Hold hands behind back and shrug shoulders
- Push against wall like you are stretching your ham strings, arms locked
- Other typical stretching exercises done during running
- Also focus on good posture, head up, chest out

I will keep checking back and hope you find some success. Again, I'm no expert and would like to hear feedback, other ideas, missing information, better techniques, etc. This is great dialogue and am curious to know what has worked from others. I am still amazed at how the body can heal itself and how much our physiology can take, however, one must listen to their own body, do their research, follow proper and proven methods and test very carefully. There is so much interconnection and factors that need to be considered before jumping into any therapy or technique. Good luck.
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Avatar_m_tn
your stretches are working for me i think.  i'll keep this updated with my progress.
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Avatar_m_tn
It's been a week since my last flare up.  I'm doing ur exercises every morning.  I can sleep now. And, the pain has gone down a lot. almost to a dull throb, but no deep pain. Thanks!
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Avatar_m_tn
Good to hear. It's all about interconnections! I've only made minor adjustments to the regimen and still the main focus is stretch & hold techniques from thumb, wrist, arms, shoulders, back and neck. Also keeping the anatomy active seems to be really important. One note for others who may be reading this thread, when I was experiencing severe pain, numbness, aching, tingling, etc. I didn't immediately start with stretch & hold techniques and aggressively using my hands/wrist — they were added gradually and I tested it carefully and, all the while, being careful with the neck region. I'd still like to hear other ideas, input, experiences, etc.
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Avatar_f_tn
I was diagnosed with DeQuervain's tendonitis June of 2013.  Its been almost a year and I am still "living" with it.  I've had 2 cortisone shots... the first one after suffering with extreme pain for 2 months... it relieved the pain almost immediately... but 3 months later the pain returned...  second shot was January 2014 the same thing pain went away, but now the pain is coming back.  My doctor also said no more shots.  Surgery would be the next step.  I am holding out... from what I've read the surgery doesnt really resolve the problem.  It is so frustrating.... there is not much information about recovery from this which makes me think that this is something that I'm stuck with forever!  I will try your exercises and hope they help.  Thanks for posting!
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Avatar_m_tn
Hello and Welcome to MedHelp (if you are new)! I have only been here about 3 weeks. I'm sorry to hear about your De Quervain's, we (I am a Orthopedic Surgical First Assistant) normally just call it Gamers Thumb. I know it can be aggravating. It sounds like you have been through all of the conservative treatment (except for splinting, which I have never been a fan of). Patients react so differently to the injections, some it will last a couple of weeks and then it may cure someone else! It sounds like a 3 month relief for you. We have had great successes post-op and it is such a easy/ quick procedure. Trust me, I'm not trying to talk you into surgery, but it sounds like your last option. Always consult with your physician before making any decisions! If you have any more questions/ concerns, please don't hesitate to contact me. I am also the Orthopedic Community Leader for MedHelp. Best Wishes!  JD1963


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Avatar_f_tn
Thanks for commenting on my DeQuervains "issue".  I guess I would like to know if left alone will it heal on its own over time? Or is this a situation that it will not heal ever...except through surgery?

Thanks!

Somers1
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Avatar_m_tn
Hi!

From my experience, I haven't seen DeQuervain's (tenosynovitis) get better by leaving it alone. I have only seen (in 25+ years) it improve with Physical Therapy/ Exercises, Injections and of course Surgery. I'm sorry I can't be of more assistance. I hope you get more posts from people that are going through the same ordeal. Please feel free though to contact me anytime for addition info on this or any other concerns!

Have a Great Day!  JD1963
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Avatar_f_tn
Thanks so much for your response. I am seeing my doctor on May 2.  I will ask his advice.  I believe that surgery is my last option, since it will be a year since the initial onset this coming June.  I'll let everyone know what the outcome is.

Thanks again,

S
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Avatar_m_tn
Hello. I'm curious to hear about your doctor visit and what YOU have decided as a course of action. It sounds like you've done your research on the surgery "option" and assume you've read through my string of posts / full story, but I've managed to keep my case of de Quervain well under control and no flare-ups through a simple regimen of stretch & hold techniques down from the neck to the hands. Yes, amazing all the information and misinformation out there and a lot to consider when there are so many stories of surgery cases where it comes back or further complications. I, too, was desperate to find a "cure" and had tried almost everything for the pain, stiffness, aching, inability to function normally. Agree, no more Cortisone shots - it only treats the symptoms for a period of time and can't overuse steroids. Agree no splinting - immobilization didn't work for me and keeping the anatomy active didn't make it any worse and seemed to help with good blood flow. Also, agree, every case is different and you never know how a patient will respond. However, I would highly recommend doing a bit more homework before considering surgery. You are your own advocate for your health. Also, I've never heard from any clinician, ortho doc, PT, etc. about what really causes dQ and what's going on with the anatomy. If there is any question on what's really causing you the pain I would not jump to surgery. I've heard everything from tendonitis and tenosynovitis, inflammation of the sheath around the tendons in the wrist, subluxation in the joints, diet-related / deficiencies, combination of nerve involvement that emanates from the lower neck region, etc. Overuse may aggravate the condition, but I'm not convinced it's the cause. With any surgery there's risk and it may work for many, but it may be worth trying some non-invasive treatments. Again, I'm no expert and am always looking for other ideas, explanations, feedback, corrections, etc. since there may always be a level of having to live with it with or without surgery. Will keep checking back.
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Avatar_f_tn
Hi Thanks for your post!  I did see my general doctor on May 2. He was the one that sent me to the orthopedic doctor for the cortisone shots. I told him that I still have pain although its gone from a 20 to about a 3 or 4. The pain is also a bit different.  I now can do the Finkelstein test with no problem at all.  I have had a history of ganglion cysts...and i noticed a small lump on the inside joint of my wrist... Maybe just maybe the cortisone shots worked for the DQ and my problem now is a cyst?!?!?! I have read that cysts can accompany DQ.  My doctor has now referred me to a hand/wrist specialist and I will go from there.  My appointment is on May 20.  I am researching every avenue to avoid surgery... to me it doesnt make sense... if its the sheath and/or tendons that is inflamed, opening that up to make room? That doesnt seem to be resolving the inflamation (inflammation) problem?? I agree DQ is a mystery. I find it really amazing that a "cure" for something as minor, yet extremely painful, has not been found since 1895!! More after May 20th!
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Avatar_m_tn
I was just curious to see how things have gone.  I posted in aug 2013 above.  I did try the neck and shoulder exercises and everything else.  I was diagnosed in June 2013 with DQ in both wrists.  While everything I did "helped" at the most my pain level would be a 1-3 while doing activity.  So, in May 2014 I decided to have the DQ release surgery on the right wrist first. It's been about 6 and a half weeks post op.  The number of weeks to heal is at least 8 weeks.  I already can breathe easier.  That sharp pain where he released the tendon on the right is no longer there.  I may have developed arthritis in the first joint on the thumb.  But that is nothing compared to the sharp pain on the DQ tendon at the wrist.  So, after the 8 months of trying splints, shots, ect. I gave in.  My Dr. was very happy about that decision and he did the job well.  Nothing else would help.  He said the tendon was in there SO tight nothing would have helped.  AND, if you "let it go", what also happened is that the tendon rubs against the joints.  The joint synovial area got inflamed AND he had to go in and cutaway 2 spots of inflammation off of the joints.  So, people I'm just saying I wouldn't wait more than a year to get this thing resolved.  So, with that, I've been off work (I work where there is repetitive typing all day).  And I'm awaiting for word for the 2nd surgery on my left wrist.  The Dr. is one of the top Dr.'s in the state. He works on the Lakers and Dodgers.  So, I don't feel afraid about the surgery.  I was incapacitated for 10 days in a cast, then I was in therapy and still incapacitated for another 5 weeks afterwards.  So, I'm looking at another 8 weeks where I'm incapacitated and I live on my own.  I do have the option of getting groceries delivered and having a maid come in twice a month while I'm going thru this.  My company allows me to have up to 6 months off if needed.  I'm just glad I'm doing this now.  I don't know what my life will be in a year.  Will I be laid off, different company, ect?  But, I'm glad I made the decision now while I can to have this surgery. I was never totally happy while working with this pain.
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Avatar_f_tn
Hi all,

Well I decided to have the surgery also.  I had been dealing with this for one year.  I had the surgery May 28th.  As with Quemo's comment above... I too had a splint/cast for 10 days afterwards.  I choose to get knocked out...surgery only took 20 minutes.  The doctor had said it was a good decision... that there was a lot of inflammation.  The first night I experienced extreme throbbing pain and had to take pain killers throughout the night.  By the next morning there was no pain.  The cast came off June 10 and I have physical therapy twice a week for a month.  I am pain free!!! My surgeon also said that there is only a 5% chance that it can return!!    My only regret is that I waited to have this done!  Good luck everyone!
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