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After surgery

After De Quervain's Release

What to expect in the first few days and weeks after surgery to release the thumb-side wrist tendons.

What was done

The tight tunnel (the first dorsal compartment) over the thumb-side tendons at the wrist was opened, so the two tendons (extensor pollicis brevis and abductor pollicis longus) can glide without catching. You have a small incision on the thumb side of the wrist covered with a soft dressing or a light thumb-spica wrap.

The first 5 days

  • Keep the dressing on, clean, and dry.
  • Keep the hand elevated above the level of your heart as much as possible. This is the most useful thing you can do for swelling and pain in the first few days.
  • Move the fingers and thumb through a comfortable range several times a day. Making a gentle fist and slowly opening the hand, and moving the thumb in small circles, prevents stiffness.
  • You may use the hand for light tasks (eating, getting dressed, using a phone). Do not grip, lift, or pinch forcefully yet.
  • No lifting more than 5 pounds (about a gallon of milk) with the operated hand.

Day 5: dressing comes off

  • Remove the dressing 5 days after surgery. You can shower and wash over the incision with soap and water; pat it dry.
  • Cover the incision with a simple adhesive bandage for a few more days, or leave it open once it is dry and closed.
  • No soaking (baths, pools, hot tubs) for 2 weeks after surgery.

Pain and expected symptoms

  • Most patients take over-the-counter pain medicine (acetaminophen/Tylenol or ibuprofen/Advil) for the first few days. Many do not need the prescription pain medicine at all.
  • Ice over the dressing (20 minutes on, 20 off) helps with swelling during the first 2 to 3 days.
  • A small area of numbness or tingling on the back of the thumb and the web space is common after this surgery because small branches of the superficial radial nerve run through that area and are easily irritated. Most of this settles over weeks to a few months, but a small patch of numbness can occasionally be permanent.
  • Tenderness on the thumb side of the wrist, particularly when making a tight fist with the thumb tucked inside (the "Finkelstein" motion you were shown in clinic), improves gradually over 4 to 6 weeks.
  • Grip and pinch strength feel weak for several weeks; this is normal and recovers.

Activity

  • Driving: when you can make a comfortable fist and move the thumb freely, and feel safe one-handed on the wheel (usually 3 to 5 days).
  • Typing / desk work: right away, in moderation.
  • Return to light work: most office workers return within a week.
  • Return to heavy manual work or forceful pinching: 4 to 6 weeks.
  • Baby lifting: de Quervain's often appears in new parents. Avoid repeatedly lifting a baby with the thumb-first, scoop-under-the-armpits motion for the first 4 weeks, and then use both hands from underneath whenever possible going forward.
  • Therapy: most patients do not need formal hand therapy. If the wrist feels stiff or tender at your follow-up visit, we will arrange it.

Follow-up

Come to the office 10 to 14 days after surgery for a wound check and suture removal. We will see you again at 6 weeks.

Call the office right away if
  • You have a fever over 101°F
  • The incision is draining pus, is spreading red, or is very warm
  • Pain is worsening instead of improving after the first few days
  • You develop severe numbness in the thumb or the back of the hand that does not improve
  • You have worsening swelling of the hand or a feeling that the hand is pale or cold

Related

About de Quervain's tenosynovitis · Home hand therapy

Questions?

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