Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores

Abstract

BackgroundFew 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.MethodsFrom 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.ResultsIn 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.ConclusionsIntracompartment 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.

One portal endoscopic release of the first extensor compartment in de Quervain's disease

“…The EPB tendon runs in a separate subcompartment of the first compartment in 27–79% (Table 3). 11, 12, 13, 14 In current study, we found a 40% rate for this situation. Authors warning about the insufficient results with patients de Quervain release may be related of neglected subcomparmental EPB presence 11, 15.…”

“…Authors warning about the insufficient results with patients de Quervain release may be related of neglected subcomparmental EPB presence 11, 15. Surgical treatment of the first extensor compartment for de Quervain's disease with a longitudinal or transverse incision has been accepted as an effective procedure in patients who are not responded to non-operative treatment 13, 14, 16, 17, 18, 19. However, there are some reasons to consider an endoscopic approach to first dorsal compartment release rather than a traditional open release.…”

Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial

“…While surgical management of de Quervain has been associated with successful outcomes, 13 patients are traditionally managed initially with conservative treatment. 6,19 Nonsurgical options previously discussed in the literature include corticosteroid injection (CSI), nonsteroidal anti-inflammatory drugs, thumb spica casting, and physical therapy.…”

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

“…DQR is reserved for selected patients with ongoing pain and decreased function despite maximized nonoperative treatment. [3][4][5] Substantial efforts have previously been made to assess clinical outcomes following DQR, [6][7][8][9][10] although prior work elucidating factors that influence surgical treatment costs is lacking in the current literature. Such information may help to guide treatment of patients with De Quervain tendinopathy, as the treating surgeon has several treatment choices to consider when surgically treating indicated patients.…”