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De Quervain’s Release
De Quervain’s release is day surgery to free the thumb tendons at the wrist when splinting, injection and anti-inflammatory medication haven’t settled the pain.
At a glance
Anaesthetic
Local anaesthetic (wide awake), sedation, or general anaesthetic at The Avenue Hospital
Where
The Avenue Hospital
Hospital stay
Day case - home the same day
First post operative review
Approximately two weeks after surgery
Driving
No driving for 1 week after surgery, then as tolerated
Post Operative Hand Therapy
Mandatory
Splinting
No routine splint after surgery - early movement is encouraged
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Many activities normal by 3-4 weeks; the wrist commonly feels fully recovered by 2-3 months
What is de Quervain's release?
De Quervain’s release is a day-case operation that divides the tight band of tissue (retinaculum) over the swollen thumb tendons at the wrist, freeing them and removing the inflamed tissue around them. It is considered when splinting, corticosteroid injection and anti-inflammatory medication haven’t given lasting relief.
Who is this procedure for?
- Persistent pain and swelling on the thumb side of the wrist that limits thumb and wrist movement
- Symptoms that haven't settled with splinting, activity changes and anti-inflammatory medication
- A corticosteroid injection hasn't given lasting relief, or symptoms keep recurring
- Confirmed de Quervain's tenosynovitis (tendinitis) on examination
Dr Tomlinson will discuss whether de Quervain’s release is appropriate for you at your consultation.
What does the surgery involve?
Under local anaesthetic, sedation, or general anaesthetic, a small (about 2cm) incision is made over the thumb side of the wrist. The tight band of tissue (retinaculum) covering the swollen tendons is divided, the tendons are freed from adhesions, and the inflamed tissue around them is removed.
Alternatives to surgery
De Quervain’s release is one option for de Quervain’s tenosynovitis. Non-surgical treatment under the guidance of a hand therapist is tried first and can include:
- wearing a splint that immobilises the wrist and thumb, worn at all times except bathing;
- a corticosteroid injection to the inflamed tendon sheath, given under ultrasound guidance;
- anti-inflammatory medication such as ibuprofen; and
- a graduated return to stretching and movement after around 4 weeks of rest.
Surgery is considered when persistent non-surgical treatment fails, or is unlikely to succeed. Dr Tomlinson will discuss which options suit you at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it may be less expensive and more convenient.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer. As a guide for this procedure: many people manage light desk-based work within 1-2 weeks; manual or repetitive hand use often needs 3-4 weeks. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
It’s advisable to plan not to drive for 1 week after de Quervain’s release.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions. (If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.)
How long will I need to wear a splint?
There is generally no post-operative splint after de Quervain’s release. Gentle movement of the thumb and wrist, usually starting within the first week, is encouraged under the guidance of your hand therapist to prevent stiffness and adhesions.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Yes. It is mandatory that you see a hand therapist after de Quervain’s release. We generally recommend that this be within 72 hours of your surgery, and will contact your nominated hand therapy group to request that they schedule an appointment for you within this timeframe. A hand therapist will guide your early movement and recovery after surgery, and may well have been involved in your non-surgical treatment prior to surgery.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of de Quervain's release surgery
In addition to the general risks of hand surgery, this specific procedure includes the risk of:
- Irritation of or damage to a small sensory nerve (the superficial radial nerve) that runs near the site of surgery, which can cause temporary pain, burning or numbness on the back of the hand near the thumb. This usually settles over several weeks, though can occasionally be more persistent.
- Incomplete release of a subcompartment. Dr Tomlinson examines carefully at the time of surgery for multiple subcompartments within the tendon sheath, as separate compartments are quite common. Failure to identify and release these leads to persisting symptoms
- A sensation of the tendons flicking, snapping or catching at the wrist during certain movements, if the released tendons shift out of their usual position. Dr Tomlinson minimises this risk with the surgical technique used.
- Recurrence of de Quervain’s tenosynovitis after surgery is rare.
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6 to 24+ hours; your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. Begin gentle thumb and wrist movement within the first three days, guided by your hand therapist, to avoid stiffness and adhesions.
Second week
No driving for one week, and then only resume driving if you can grip the steering wheel strongly with both hands and take evasive action in the case of an emergency. Continue gentle movement; scar sensitivity and mild discomfort with use is expected.
6 weeks
Most light activities, including desk-based work, are usually comfortable by 3-4 weeks.
3 months
The wrist commonly feels fully recovered by 2-3 months.
Long term
Recurrence of de Quervain's tenosynovitis after surgery is rare.
Want to know more about de Quervain’s release?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.