A Prospective Evaluation of the Anatomy of the First Dorsal Compartment in Patients Requiring Surgery for De Quervain's Tenosynovitis

Jonas L. Matzon; Jack G. Graham; Kevin F. Lutsky; T. Robert Takei; Gregory G. Gallant; Pedro K. Beredjiklian

doi:10.1055/s-0039-1688700

Journal of Wrist Surgery, Table of Contents

J Wrist Surg 2019; 08(05): 380-383
DOI: 10.1055/s-0039-1688700

Scientific Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Prospective Evaluation of the Anatomy of the First Dorsal Compartment in Patients Requiring Surgery for De Quervain's Tenosynovitis

Jonas L. Matzon

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Jack G. Graham

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Kevin F. Lutsky

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

T. Robert Takei

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Gregory G. Gallant

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

,

Pedro K. Beredjiklian

¹Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

› Author Affiliations

Abstract

Background We prospectively evaluated the surgical anatomy during first dorsal compartment release for De Quervain's tenosynovitis, with special attention to the superficial branch of the radial nerve (SBRN). Additionally, the incidence of tendon instability during surgery was assessed.

Methods This prospective cohort study consisted of 130 De Quervain's patients undergoing first dorsal compartment release. The treating surgeons recorded the type of incision used, the number of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slips, the number of SBRN branches encountered, additional subcompartments created by any septations, and active/passive tendon stability.

Results A singular first dorsal compartment was found in 37% of cases, whereas 55% of patients had two subcompartments and 8% had three. Multiple APL tendon slips (range: 1–4) were identified in 78% of patients. In contrast, a single EPB tendon was found in 92% of patients (range: 0–2). At least one SBRN was encountered in 61% of cases. Following surgery, instability was evident in 9% of patients, who had tendons perch with passive wrist flexion. In one of these patients (<1%), the tendons dislocated volarly out of the first dorsal compartment during active flexion.

Conclusions The anatomical findings in our relatively large, prospective study of De Quervain's patients undergoing first dorsal compartment release are consistent with previous smaller and/or retrospective studies. Overall, we expect to encounter the SBRN during first dorsal compartment release in more than 50% of patients but are unconcerned if it is not visualized during a careful approach. Tendon instability has an incidence of 9%; however, dislocation is rare (<1%).

Keywords

De Quervain's tenosynovitis - first dorsal compartment - surgical anatomy - wrist

Full Text

References

References
1 Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain's disease. A study of operative findings. Int Orthop 1995; 19 (04) 209-211
2 Alemohammad AM, Yazaki N, Morris RP, Buford WL, Viegas SF. Thumb interphalangeal joint extension by the extensor pollicis brevis: association with a subcompartment and de Quervain's disease. J Hand Surg Am 2009; 34 (04) 719-723
3 Gousheh J, Yavari M, Arasteh E. Division of the first dorsal compartment of the hand into two separated canals: rule or exception?. Arch Iran Med 2009; 12 (01) 52-54
4 Harvey FJ, Harvey PM, Horsley MW. De Quervain's disease: surgical or nonsurgical treatment. J Hand Surg Am 1990; 15 (01) 83-87
5 Mazurek MT, Shin AY. Upper extremity peripheral nerve anatomy: current concepts and applications. Clin Orthop Relat Res 2001; (383) 7-20
6 Auerbach DM, Collins ED, Kunkle KL, Monsanto EH. The radial sensory nerve. An anatomic study. Clin Orthop Relat Res 1994; (308) 241-249
7 Abrams RA, Brown RA, Botte MJ. The superficial branch of the radial nerve: an anatomic study with surgical implications. J Hand Surg Am 1992; 17 (06) 1037-1041
8 White GM, Weiland AJ. Symptomatic palmar tendon subluxation after surgical release for de Quervain's disease: a case report. J Hand Surg Am 1984; 9 (05) 704-706
9 McMahon M, Craig SM, Posner MA. Tendon subluxation after de Quervain's release: treatment by brachioradialis tendon flap. J Hand Surg Am 1991; 16 (01) 30-32
10 Collins ED. Radial ridge excision for symptomatic volar tendon subluxation following de Quervain's release. Tech Hand Up Extrem Surg 2014; 18 (03) 143-145
11 Burton RI, Littler JW. Tendon entrapment syndrome of first extensor compartment (de Quervain's disorder). Curr Probl Surg 1975; 12: 32-34
12 Lee ZH, Stranix JT, Anzai L, Sharma S. Surgical anatomy of the first extensor compartment: a systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. J Plast Reconstr Aesthet Surg 2017; 70 (01) 127-131
13 Dellon AL, Mackinnon SE. Susceptibility of the superficial sensory branch of the radial nerve to form painful neuromas. J Hand Surg Br 1984; 9 (01) 42-45