Triggering of the abductor pollicis longus in association with deQuervain's tenosynovitis

Abstract

DeQuervain's tenosynovitis is a common cause of radial-sided wrist pain. Symptoms result from a narrow first dorsal compartment and associated tendinosis of the enclosed extensor pollicis brevis and/or abductor pollicis longus (APL). Surgical intervention, offered when conservative measures fail to adequately relieve symptoms, requires a detailed understanding of potentially aberrant anatomy in order to avoid persistence or recurrence of symptoms. We describe a case whereby the patient presented with complaints of thumb triggering in extension and associated disabling first dorsal compartment tendinosis. Intraoperatively, after supernumerary tendons were identified and addressed, the APL was at risk for subluxation over a prominent fibroosseous ridge. Routine first dorsal compartment release alone may have failed to address all of this patient's pathology.

Posttraumatic triggering of the extensor pollicis brevis tendon in de Quervain's disease successfully diagnosed with ultrasonography: A case report

“…3 It was first reported in a child in 1979, which probably should not be considered a true de Quervain's tenosynovitis, and later reported in several small case series that comprise a total of 14 operative cases. [1][2][3][4][5][6] We found only one posttraumatic case of snapping de Quervain's disease similar to the present case. 3 Ultrasound has been used for the assessment of de Quervain's disease and has appeared to be a useful tool in the investigation of triggering or snapping tendons in various regions of the body.…”

“…Triggering is an uncommon symptom in de Quervain's disease with a prevalence of only 1.3% based on a review of 827 consecutive patients over a 5‐year period 3 . It was first reported in a child in 1979, which probably should not be considered a true de Quervain's tenosynovitis, and later reported in several small case series that comprise a total of 14 operative cases 1‐6 . We found only one posttraumatic case of snapping de Quervain's disease similar to the present case 3 .…”

“…7,8 However, to As previously reported, triggering of the first dorsal compartment may result from nodularity in the EPB, APL, or both tendons in association with stenosis and synovitis in the fibro-osseous tunnel. [1][2][3][4] In this posttraumatic case, the presence of a discolored hourglass-shaped nodule in the EPB tendon probably represents the intratendinous healing process after a traumatic direct and/or indirect tendon damage.…”

“…1,9 Others have recommended release of both subcompartments for EPB and APL tendons because they might have nodularity. [2][3][4]10 To resolve this problem, preoperative sonography helps identify the nodularity in the EPB and/or APL tendons with or without tenosynovitis and decide which subcompartment to release. Moreover, the "wide-awake local anesthesia no tourniquet (WALANT)" surgical technique is also useful to determine the snapping subcompartment and to confirm the disappearance of snapping after the release under voluntary movements of the patient's thumb intraoperatively.…”

“…After decompressing only the EPB subcompartment, we confirmed the disappearance of the snapping during the patient's active intraoperative movements of his thumb. To prevent the released EPB tendon from volar subluxation, the tendon sheath was loosely reconstructed with the retinacular sling flap using the dorsal end of the remnant sheath 4 . Finally, snapping and entrapment of the EPB tendon were resolved without tendon subluxation during the active thumb and wrist movements.…”