Complications of a Simple Procedure: De Quervain's Disease Revisited

Mellor, Simon; Ferris, Barry

doi:10.1111/j.1742-1241.2000.tb11853.x

Cited by 34 publications

(2 citation statements)

References 7 publications

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“…The main complications following surgical release include incomplete release of tendon subcompartments, delayed wound healing, tendon subluxation, RSN damage sometimes resulting in a neuroma, hypertrophic scarring, peritendinous adhesions, growth of a ganglion, and recurrence of symptoms. 10,14,21,[23][24][25] Of the patients contacted who had a reoperation, we identified similar findings, with three patients with an incomplete release of the tendon, one patient with a RSN neuroma, two patients with a tendon sheath cyst, and one patient developed tendon subluxation. Furthermore, one patient developed an epidermal inclusion cyst.…”

Section: Discussionmentioning

confidence: 74%

“…13 Dissatisfaction can be caused by incomplete surgical release of the tendon, tendon subluxation, radial sensory nerve (RSN) injury or scarring, 7,10,11 reflex sympathetic dystrophy, 12 and poor cosmetic outcomes. 14 We identified a large cohort of patients at our institution who underwent de Quervain's release and sought to identify factors that influence patient-reported outcomes along with reporting the reintervention rate following surgery in this cohort.…”

Section: Introductionmentioning

confidence: 99%

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Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis

Zamri

Lans

Eberlin

et al. 2023

Journal of Hand and Microsurgery

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Objective The aims of this study are to describe and identify the factors that influence patient reported outcomes following surgery of de Quervain's tenosynovitis. The secondary objective is to report the rate of reintervention following surgery of de Quervain's tenosynovitis. Patients and Methods Outcomes using the numerical rating scale (NRS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), the Patients Reported Outcome Measurement Information System Pain Interference (PROMIS PI), and a custom de Quervain's questionnaire were obtained. A multivariable linear regression analysis was performed to identify independent factors associated with patient-reported outcomes. Results Seventy-six patients who underwent de Quervain's release participated. The average age was 52.8 years (95% confidence interval: 49.6–56.1) and median follow-up age was 7.0 years (interquartile range [IQR]: 4.3–12.0). Outcomes were: NRS of pain was 0 (IQR: 0.0–3.0), the median QuickDASH was 6.82 (IQR: 0.00–28.41), the median PRWE score was 4.0 (IQR: 0.00–18.50), and the median PROMIS PI score was 43.90 (IQR: 38.70–53.90). Eighteen (23.7%) of the patients reported pain with thumb activities, four of whom had a reintervention. Additionally, 21 (26.9%) patients reported decreased strength in the thumb compared to the contralateral side, of which two underwent a reintervention. In total, eight patients underwent reintervention of which seven had a second surgery and one had a cortisone injection. Conclusion Roughly 1 in 20 patients following de Quervain's release undergoes reintervention. Patients with high PROMIS PI scores report poor surgical outcomes more frequently. Patients with high PROMIS PI scores report higher NRS pain scores (p < 0.05), higher QuickDASH scores (p < 0.05), and higher PRWE scores (p < 0.05). In practice, careful consideration of PROMIS PI scores and psychosocial factors are recommended before considering reintervention.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis

Zamri

Lans

Eberlin

et al. 2023

Journal of Hand and Microsurgery

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Applied anatomy of the superficial branch of the radial nerve

Robson¹,

See²,

Ellis³

2007

Clinical Anatomy

101

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The superficial branch of the radial nerve (SBRN) is highly vulnerable to trauma and iatrogenic injury. This study aimed to map the course of the SBRN in the context of surgical approaches and identify a safe area of incision for de Quervain's tenosynovitis. Twenty-five forearms were dissected. The SBRN emerged from under brachioradialis by a mean of 8.31 cm proximal to the radial styloid (RS), and remained radial to the dorsal tubercle of the radius by a mean of 1.49 cm. The nerve divided into a median of four branches. The first branch arose a mean of 4.92 cm proximal to the RS, traveling 0.49 cm radial to the first compartment of the extensor retinaculum, while the main nerve remained ulnar to it by 0.64 cm. All specimens had branches underlying the traditional transverse incision for de Quervain's release. A 2.5-cm longitudinal incision proximal from the RS avoided the SBRN in 17/25 cases (68%). In 20/25 specimens (80%), the SBRN underlay the cephalic vein. In 18/25 (72%), the radial artery was closely associated with a sensory nerve branch near the level of the RS (SBRN 12/25, lateral cutaneous nerve of the forearm (LCNF) 6/25.) A longitudinal incision in de Quervain's surgery may be preferable. Cannulation of the cephalic vein in the distal third of the forearm is best avoided. The close association between the radial artery and first branch of the SBRN or the LCNF may explain the pain often experienced during arterial puncture. Particular care should be taken during radial artery harvest to avoid nerve injury.

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Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon

Kim

Lee

Khil

et al. 2020

J of Ultrasound Medicine

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ObjectivesWe performed preoperative ultrasonography (US) to detect the anatomic course of the superficial radial nerve (SRN) and dominant pathologic tendon of the first extensor compartment in de Quervain tenosynovitis.MethodsWe prospectively studied 27 patients (29 wrists) with de Quervain tenosynovitis who underwent surgical release of the first extensor compartment. Preoperatively, US was performed to evaluate the presence of the dominant pathologic tendon and the septum in the subcompartment, number of SRNs in the area of the surgical incision, and anatomic running course of the SRN. These variables were also checked intraoperatively. Cohen κ statistics were calculated to investigate agreement between US and surgical field findings.ResultsThere were 7 men and 20 women (mean age, 47.8 years; range, 26–67 years). For the dominant pathologic tendon, there were 2 cases (6.9%) of an abductor pollicis longus, 11 cases (37.9%) of an extensor pollicis brevis, and 16 cases (55.2 %) of a nondominant tendon (κ = 0.94). For the subcompartment, there were 10 cases (34.5%) without a septum, 8 (27.6%) with an incomplete septum, and 11 (37.9%) with a complete septum (κ = 0.95). Most SRNs crossed over the first extensor compartment (κ = 0.78).ConclusionsPreoperative US can be useful in detecting the anatomic running course of the SRN and dominant pathologic tendon before surgery for de Quervain tenosynovitis. Classifying the anatomic course of the SRN could be essential to planning surgery, and it could be helpful to prevent injury of the SRN during surgery.

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Complications of a Simple Procedure: De Quervain's Disease Revisited

Cited by 34 publications

References 7 publications

Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis

Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis

Applied anatomy of the superficial branch of the radial nerve

Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon

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