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Evaluating the Impact of Early Rehabilitation and Socioeconomic Deprivation Following de Quervain's Tenosynovitis Release
Joshua K. Kim, BS
1, Joey Liang, BS
1, Ethan Song, M.D.
2, Warren C. Hammert, MD
3; Suhail K. Mithani, MD
2(1)Duke University School of Medicine, Durham, NC, (2)Duke University Medical Center, Durham, NC, (3)Duke University, Durham, NC
HypothesisSurgical release for de Quervain's tenosynovitis often provides functional improvement and pain relief, but is not curative for a subset of patients. Hand therapy may provide benefits in these cases, but its efficacy and implementation in the postoperative setting remain unclear. This study assesses the effectiveness and indications for hand therapy following de Quervain's release. We hypothesize that early postoperative hand therapy following surgical release for de Quervain's tenosynovitis improves short-term pain and function. Additionally, we propose that socioeconomic deprivation is associated with worse early outcomes, independent of therapy or clinic attendance.
Materials and MethodsPatients who underwent first dorsal extensor compartment release for de Quervain's tenosynovitis from 2014 to 2024 were included. Demographics, area of deprivation index, postoperative clinic and therapy visits, PROMIS, and QuickDASH scores were recorded. Bivariate analysis compared patients by socioeconomic status and therapy attendance.
ResultsIn total, 897 patients were included. Hand therapy was discussed with 498 (67.6%) patients, with 305 (41.4%) ultimately attending therapy for 2 [1, 3] sessions over 1.6 [0, 6] weeks. Patients engaging in hand therapy within four weeks postoperatively had more favorable Pain Interference (PI) (p=0.009), Physical Function (PF) (p=0.016), QuickDASH (p=0.025), and subjective pain (p=0.016) at six weeks. However, functional differences were equalized by three months. Despite similar hand therapy and clinic attendance, patients with a greater socioeconomic deprivation had worse initial PI at six weeks (p=0.023), and less favorable PI and PF at the time of the latest encounter.
ConclusionsHand therapy effectively reduces residual pain and functional impairments following de Quervain's tenosynovitis release. Hand therapy may be initiated within four weeks postoperatively to temporize functional deficits and pain in patients, but operative release is the primary driver of long-term outcomes. Socioeconomic disparities in de Quervain's tenosynovitis outcomes exist irrespective of hand care and therapy attendance.
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