Dequervain’s Tenosynovitis Protocol

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Surgical Procedure

DeQuervain’s tenosynovitis is swelling and inflammation of the two thumb tendons (extensor pollicis brevis, extensor pollicis longus) as they pass through a single tendon sheath at the wrist. The first dorsal compartment release procedure begins with an incision being made along the dorsal, radial side of the wrist. The tendon sheath is released, relieving pressure and friction. This surgery allows the tendons to glide freely when moving the thumb and wrist.  Typically, dissolvable sutures are used to close the skin which will not need to be removed postoperatively.

When you go home from surgery, you will have light dressings placed to cover your incision. A splint is not typically necessary following this procedure. You will have immediate mobility of all fingers. Dressings may be removed and changed approximately 3 days after surgery. The incision should remain covered and kept dry until your first post-op appointment or 7-10 days after surgery.

NOTES: Post-op therapy will likely be brief and will emphasize the home exercise program/scar management techniques.

Initial Post-op Visit:

• Dressing:
  • Bulky dressing is removed, and a light compressive dressing is applied.

• Exercise:
  • Full Active/Passive Range of Motion, tendon gliding exercises for digits and thumb.
  • Full Active/Passive Range of Motion of the wrist, forearm, and elbow.
• Education:
  • Full use of the involved extremity for activities of daily living (ADLs).
  • Avoid heavy gripping, lifting, and repetitive wrist motion.

10-14 Days Post-op:

• Therapist authorized to remove sutures if still in place/if applicable
• Once the incision is completely healed, scar management techniques may be initiated.
  • Scar massage
  • Use of silicone gel sheeting
  • Scar desensitization
• Manual desensitization techniques are initiated due to hypersensitivity along a superficial branch of the radial nerve.
• Dynamic splinting and/or taping may be initiated to the thumb if the Passive Range of Motion is limited

3-4 Weeks Post-op:

• Progressive strengthening may be initiated at this time.
• Encourage normal functional use of the hand.

Considerations

Patient education becomes important to return to work and normal daily activities. The patient is advised to avoid activities requiring sustained pinch in combination with wrist ulnar deviation and/or wrist flexion. Typically, patients will have restored ROM and function within 3-4 weeks following surgery.

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