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Have Pain In Wrist, Thumb, Radiating To Shoulder. Diagnosed With De Quervain's Synovitis. How Long Should Medicines Be Taken?
Question: Hi ,
My wife, age 54 years has been suffering from pain in her left wrist and thumb from October 2012. Recently the pain is radiating to the shoulder as well. She consulted a doctor and underwent an USG of the wrist and X-Ray Spine. The reports and the doctor’s prescription are attached. The diagnosis is De quervain’s synovitis. She also underwent test for C-reactive protein and it is negative. Her doctor has prescribed her some medicines and suggested intra-articular injections followed by surgery as the final resort. She had taken intra-articular injections for the same complaint several years back. Her sugar and cholesterol levels are normal.
I am attaching the USG Report, XRay report and two prescriptions from doctors.
My questions are:
1. For how long should she take the medicines for symptoms to get better? Are the medicines prescribed to her the best option. She often complains of gas after taking the medicines (in spite of taking Zantac) and has not been able to take them as prescribed.
2. What course of treatment would you advise in her case?
3. Should she go for injections or surgery as advised by her doctor?
Regards,
XXXXXXX
My wife, age 54 years has been suffering from pain in her left wrist and thumb from October 2012. Recently the pain is radiating to the shoulder as well. She consulted a doctor and underwent an USG of the wrist and X-Ray Spine. The reports and the doctor’s prescription are attached. The diagnosis is De quervain’s synovitis. She also underwent test for C-reactive protein and it is negative. Her doctor has prescribed her some medicines and suggested intra-articular injections followed by surgery as the final resort. She had taken intra-articular injections for the same complaint several years back. Her sugar and cholesterol levels are normal.
I am attaching the USG Report, XRay report and two prescriptions from doctors.
My questions are:
1. For how long should she take the medicines for symptoms to get better? Are the medicines prescribed to her the best option. She often complains of gas after taking the medicines (in spite of taking Zantac) and has not been able to take them as prescribed.
2. What course of treatment would you advise in her case?
3. Should she go for injections or surgery as advised by her doctor?
Regards,
XXXXXXX
Hi, thanks for writing to XXXXXXX
My answers for your questions
(1) Generally, the pain in this condition is caused by either overuse or after attending unaccustomed activities.At rest this condition will not give rise to pain.
So medicines have to be taken as and when necessary and not regularly.
All pain killer medicines results in gastritis over prolonged usage and there is no way one can avoid it. Your doctor has prescribed good medications.
(2) As the symptoms are there since 7 months (as per the scanned prescription), I think medicines are not going to work in her. I suggest just to avoid the movements which causes her pain.
(3) Ideally, injections are to be tried first before surgery. But the skill of the doctor dictates the outcome after injection. Actually the injection has to be given into the tendon sheath which gives good results. If by chance, it is given into the tendon, then it leads to more pain and at times tendon degeneration and rupture will occur.
(3) Surgical release will give consistently good results and one can go home the day after surgery. Surgery will also give immediate pain relief.
Hope I have addressed all your issues. Happy to help if you need any more clarifications.
Good day.
My answers for your questions
(1) Generally, the pain in this condition is caused by either overuse or after attending unaccustomed activities.At rest this condition will not give rise to pain.
So medicines have to be taken as and when necessary and not regularly.
All pain killer medicines results in gastritis over prolonged usage and there is no way one can avoid it. Your doctor has prescribed good medications.
(2) As the symptoms are there since 7 months (as per the scanned prescription), I think medicines are not going to work in her. I suggest just to avoid the movements which causes her pain.
(3) Ideally, injections are to be tried first before surgery. But the skill of the doctor dictates the outcome after injection. Actually the injection has to be given into the tendon sheath which gives good results. If by chance, it is given into the tendon, then it leads to more pain and at times tendon degeneration and rupture will occur.
(3) Surgical release will give consistently good results and one can go home the day after surgery. Surgery will also give immediate pain relief.
Hope I have addressed all your issues. Happy to help if you need any more clarifications.
Good day.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for your answer doctor. It is very helpful. Couple more things that we wanted to clarify.
1.As I mentioned in my query, she had received two injections at 3 months gap in the same wrist 19 years back. Is it safe for her to take another injection now?
2. Do you agree with the diagnosis. Or is there a possibility that her pain is being caused by some other condition. Because she does experience pain at rest also. In fact it is quite bad at night.
1.As I mentioned in my query, she had received two injections at 3 months gap in the same wrist 19 years back. Is it safe for her to take another injection now?
2. Do you agree with the diagnosis. Or is there a possibility that her pain is being caused by some other condition. Because she does experience pain at rest also. In fact it is quite bad at night.
Hi, Nice to hear from you again.
(1) As it has been more than 19 years since her last injection,there is no harm in receiving an injection again as long as it is not given into the substance of the tendon (which i have mentioned already). But personally I feel that it may not work as the disease has been persisting since a long time.
(2) The diagnosis is absolutely correct and it has been confirmed by the ultrasound report also( the scanned report which you have sent me). So, no second thought regarding the diagnosis.
There is no hard and fast rule that pain should not occur at rest and there may be slight variation with regard to the perception of pain from person to person.
MY PERSONAL TIP FOR SURGERY - If a hard "nodule" is felt at the site of maximum pain, then I advice surgery for my patients. This is because the nodule forms a tight constricting band around the tendons and any slightest movement of the thumb will cause severe pain. And at this "nodule" stage, neither the medicines nor the injections will work.
Hope this information is helpful . Regards
(1) As it has been more than 19 years since her last injection,there is no harm in receiving an injection again as long as it is not given into the substance of the tendon (which i have mentioned already). But personally I feel that it may not work as the disease has been persisting since a long time.
(2) The diagnosis is absolutely correct and it has been confirmed by the ultrasound report also( the scanned report which you have sent me). So, no second thought regarding the diagnosis.
There is no hard and fast rule that pain should not occur at rest and there may be slight variation with regard to the perception of pain from person to person.
MY PERSONAL TIP FOR SURGERY - If a hard "nodule" is felt at the site of maximum pain, then I advice surgery for my patients. This is because the nodule forms a tight constricting band around the tendons and any slightest movement of the thumb will cause severe pain. And at this "nodule" stage, neither the medicines nor the injections will work.
Hope this information is helpful . Regards
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
Dr. K. Naga Ravi Prasad
Orthopaedic Surgeon, Joint Replacement
Practicing since :1996
Answered : 2148 Questions
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