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Surgical release of the first extensor compartment for refractory de Quervain's tenosynovitis: surgical findings and functional evaluation using DASH scores.

Lee HJ, Kim PT, Aminata IW, Hong HP, Yoon JP, Jeon IH - Clin Orthop Surg (2014)

Bottom Line: The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05).Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease.The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Few studies have evaluated surgical outcomes in patients with refractory de Quervain's disease using validated outcome measures. We assessed the clinical outcomes of dorsal release of the first extensor compartment for the treatment of de Quervain's disease using the disabilities of the arm, shoulder and hand (DASH) score.

Methods: From October 2003 to May 2009, we retrospectively evaluated 33 patients (3 men and 30 women) who underwent surgical treatment for de Quervain's disease. All patients had a positive Finkelstein test and localized tenderness over the first dorsal compartment. All operations were performed under local anesthesia. A 2-cm-long transverse skin incision was made over the first extensor compartment and the dorsal retinaculum covering the extensor pollicis brevis was incised longitudinally. Preoperative and postoperative clinical evaluation included the use of DASH score, Finkelstein test, and visual analogue scale (VAS) score.

Results: In 18 patients (55%), the extensor pollicis brevis tendon compartment was separated from the abductor pollicis longus compartment. Eight patients had intracompartmental ganglia in the extensor pollicis brevis subcompartment. All patients except one had negative sign on Finkelstein test at the last follow-up. The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05). There were no postoperative complications such as subluxation of the tendon of the first dorsal compartment or injury to the sensory branch of the radial nerve.

Conclusions: Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease. The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.

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The extensor retinaculum is incised longitudinally along the extensor pollicis brevis tendon.
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Figure 1: The extensor retinaculum is incised longitudinally along the extensor pollicis brevis tendon.

Mentions: All operations were performed in the day surgery unit, under local anesthesia using intravenous midazolam and pethidine. A mixture of 0.1% (w/v) lidocaine and 0.25% (w/v) bicarbonate was injected into the area of skin incision and a pneumatic tourniquet was inflated. A 2-cm long transverse skin incision was made over the first extensor compartment of the radial styloid process. Great care was taken to identify and retract the radial sensory nerve branches. The EPB tendon was exposed and identified just distal to the first extensor compartment. After lifting the EPB tendon, the extensor retinaculum covering the EPB subcompartment was incised longitudinally along the EPB tendon (Fig. 1) on its dorsal side. If there was a septum between the EPB and APL tendons, the septum was incised longitudinally. Any entanglement was double-checked by pulling and lifting up the tendon distally (Fig. 2). When we found a ganglion from the tendon sheath, we removed the mass from the tendon sheath without excision of the tendon sheath. After meticulous hemostat control, the skin was closed and a compressive dressing was applied. No immobilization was performed.


Surgical release of the first extensor compartment for refractory de Quervain's tenosynovitis: surgical findings and functional evaluation using DASH scores.

Lee HJ, Kim PT, Aminata IW, Hong HP, Yoon JP, Jeon IH - Clin Orthop Surg (2014)

The extensor retinaculum is incised longitudinally along the extensor pollicis brevis tendon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233219&req=5

Figure 1: The extensor retinaculum is incised longitudinally along the extensor pollicis brevis tendon.
Mentions: All operations were performed in the day surgery unit, under local anesthesia using intravenous midazolam and pethidine. A mixture of 0.1% (w/v) lidocaine and 0.25% (w/v) bicarbonate was injected into the area of skin incision and a pneumatic tourniquet was inflated. A 2-cm long transverse skin incision was made over the first extensor compartment of the radial styloid process. Great care was taken to identify and retract the radial sensory nerve branches. The EPB tendon was exposed and identified just distal to the first extensor compartment. After lifting the EPB tendon, the extensor retinaculum covering the EPB subcompartment was incised longitudinally along the EPB tendon (Fig. 1) on its dorsal side. If there was a septum between the EPB and APL tendons, the septum was incised longitudinally. Any entanglement was double-checked by pulling and lifting up the tendon distally (Fig. 2). When we found a ganglion from the tendon sheath, we removed the mass from the tendon sheath without excision of the tendon sheath. After meticulous hemostat control, the skin was closed and a compressive dressing was applied. No immobilization was performed.

Bottom Line: The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05).Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease.The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Few studies have evaluated surgical outcomes in patients with refractory de Quervain's disease using validated outcome measures. We assessed the clinical outcomes of dorsal release of the first extensor compartment for the treatment of de Quervain's disease using the disabilities of the arm, shoulder and hand (DASH) score.

Methods: From October 2003 to May 2009, we retrospectively evaluated 33 patients (3 men and 30 women) who underwent surgical treatment for de Quervain's disease. All patients had a positive Finkelstein test and localized tenderness over the first dorsal compartment. All operations were performed under local anesthesia. A 2-cm-long transverse skin incision was made over the first extensor compartment and the dorsal retinaculum covering the extensor pollicis brevis was incised longitudinally. Preoperative and postoperative clinical evaluation included the use of DASH score, Finkelstein test, and visual analogue scale (VAS) score.

Results: In 18 patients (55%), the extensor pollicis brevis tendon compartment was separated from the abductor pollicis longus compartment. Eight patients had intracompartmental ganglia in the extensor pollicis brevis subcompartment. All patients except one had negative sign on Finkelstein test at the last follow-up. The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05). There were no postoperative complications such as subluxation of the tendon of the first dorsal compartment or injury to the sensory branch of the radial nerve.

Conclusions: Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease. The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.

Show MeSH
Related in: MedlinePlus