Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results

Wijk, Jacobien van der; Goubau, Jean; Mermuys, Koen; Hoonacker, P. Van; Vanmierlo, Bert; Kerckhove, D.; Berghs, Bart

doi:10.1055/s-0035-1556862

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…Unsatisfactory outcome of surgical treatments include incomplete resection of the first extensor compartment, extensor tendon subluxation, formation of neuromas, painful scars, adhesion of the extensor tendon, incomplete decompression of the septum and infection (Belsole, 1981; Scheller et al., 2009; van der Wijk et al., 2015). Scheller et al.…”

Section: Discussionmentioning

confidence: 99%

“…However, there was no significant difference in rates of subluxation between the two groups. Because it is difficult to perform a revision surgery in the event of extensor tendon subluxation, various surgical methods have been proposed to prevent such complications (Bakhach et al., 2018; Littler et al., 2002; McMahon et al., 1991; Ramesh and Britton, 2000; van der Wijk et al., 2015). Takagi et al.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of extensor tendon subluxation after simple release remains unknown. There have been recent attempts to prevent volar subluxation of the extensor tendon through reconstructive surgery of the extensor compartments (Bakhach et al., 2006; Littler et al., 2002; Takagi et al., 2017; van der Wijk et al., 2015). Takagi et al.…”

Section: Introductionmentioning

confidence: 99%

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Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study

Kim

Baek

Lee

2019

J Hand Surg Eur Vol

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We compared two surgical procedures for de Quervain’s disease that was not responsive to conservative treatment. Group A (simple release) consisted of 38 patients and group B (Z-plasty of the retinaculum) included 36 patients. The visual analogue scale score and the Disabilities of the Arm, Shoulder and Hand Score improved significantly after surgery; there were no statistical differences in outcome between the two groups. In group A, one patient required reoperation, two had subluxations of extensor tendons and two had temporary loss of sensation in the area of the radial nerve. In group B, two patients had temporary loss of sensation. The mean time to resolution of pain at the operative site was significantly shorter in group B. Both simple release and Z-plasty were effective surgical methods. Z-plasty allowed earlier return to activities of daily living but there was no statistical difference between the two groups in incidence of complication. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study

Kim

Baek

Lee

2019

J Hand Surg Eur Vol

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“…Some have proposed a primary reconstruction of the pulley of the first extensor compartment to avoid the subluxation of the EPB and APL tendons after the primary surgery of de Quervain's disease. [12][13][14][15][16] Instability of the tendons of the first extensor compartment is more likely to occur following the simple release of the pulley of the first extensor compartment in early stages of the disease because the pulley is thinner. Chronic cases of de Quervain may have thickening of the pulley/retinaculum of the first extensor compartment up to more than 2 mm (measured by ultrasound).…”

Section: Discussionmentioning

confidence: 99%

Pulley Reconstruction for Symptomatic Instability of the Tendons of the First Extensor Compartment Following de Quervain's Release

et al. 2017

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Surgical management of de Quervain's tenosynovitis is based on decompression of the first extensor compartment. A simple release of the first compartment can cause instability of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons in zone seven of the extensors. The WHAT test (wrist hyperflexion and abduction of the thumb) is very effective in diagnosing this instability. In this retrospective monocentric study, we analyzed a case series of 10 patients all of whom underwent a reconstruction of the first extensor compartment using a retinacular graft because of symptomatic instability after decompression surgery. The reconstruction was a modified technique of the sixth compartment. Functional outcome and characteristics of the newly reconstructed pulley were examined by physical examination with the aid of ultrasound and internationally validated questionnaires. Four patients had a good-to-excellent functional outcome, all of those had a maximum of two surgical procedures performed on the first extensor compartment. Six patients presented poor functional outcome. In four of them, more than two surgical procedures were performed. Minor residual instability was noted in six cases, found in both the groups. The reconstruction procedures on the first compartment seemed to be satisfactory in treating instability of the EPB and APL tendons after primary surgical release for de Quervain's disease. Level IV, observational study without controls.

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“…We used the technique as described by van der Wijk et al 10 Skin and subcutaneous dissection was performed as mentioned for the release group. Consecutively the tendon sheath was dissected and incised proximal and distal to the pulley.…”

Section: Reconstruction (Group 2)mentioning

confidence: 99%

Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial

et al. 2021

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Purpose The aim of this study was to compare the results of surgeries of the De Quervain's disease (DQD) through a randomized control trial. Materials and Methods We treated 40 cases of De Quervain's tenosynovitis in 2 groups: 20 patients by pulley release method and another 20 patients by pulley reconstruction method. The patients were selected as per the random table number. The clinical data, numeric Visual Analogue Scale (VAS) score, Quick DASH—Disabilities of the Arm, Shoulder, and Hand—score, Mayo Wrist Score, and subluxation of the tendons in dynamic ultrasonography (USG) during wrist hyperflexion and abduction of the thumb test were noted preoperatively and 6 months after the operation. All patient charts were reviewed and data analysis was done after completion of the study. Results All patients improved after surgery. There was no difference in clinical outcome data, numeric VAS score, Quick DASH Score, and Mayo Wrist Score (p-value > 0.05). There were four patients with tendon subluxation under USG in pulley release group, out of which only one patient was clinically symptomatic. There was no tendon subluxation in pulley reconstruction group. The tendon subluxation between the two groups was not found to be statistically significant (p-value: 0.661). Conclusion Although, higher numbers of subluxation were found in release group, there was no statistically significant difference in the outcome of the two surgical procedures for DQD. This study is a pilot study, and it may act as the groundwork over which further studies may be performed. Level of Evidence This is a Level I study.

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Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results

Cited by 13 publications

References 20 publications

Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study

Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study

Pulley Reconstruction for Symptomatic Instability of the Tendons of the First Extensor Compartment Following de Quervain's Release

Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial

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