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Lee YS, Choi WS, Baek SH, Kang H, Lee CH. Comparative Analysis of Ultrasound and Surgical Findings in Anatomical Variations of de Quervain's Disease. Clin Orthop Surg 2025; 17:308-316. [PMID: 40170768 PMCID: PMC11957819 DOI: 10.4055/cios24127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 12/07/2024] [Accepted: 12/08/2024] [Indexed: 04/03/2025] Open
Abstract
Background This study compares ultrasound and surgical findings of anatomical variations in de Quervain's disease. Methods Seventy-four wrists from patients with unilateral de Quervain's disease were examined through ultrasonography and surgery. Presence of intracompartment septum, abductor pollicis longus (APL) slips, and selective stenosis were verified by both methods. Two orthopedic surgeons assessed ultrasound findings for intra- and interobserver reliability. Results Amongst 74 participants (43 women and 31 men), 60.8% had a complete septum, 31.1% had an incomplete septum, and 8.1% had no septum; 70.3% had multi-slip APL and 66.2% had extensor pollicis brevis stenosis. Surgical and ultrasonographic findings displayed a high level of sensitivity and specificity. Intraobserver reliability was high, and interobserver reliability was substantial. Conclusions The study confirms ultrasonography's reliability in identifying anatomical variations in de Quervain's disease, with high sensitivity, specificity, and substantial intra- and interobserver reliability, emphasizing its usefulness in preoperative assessment and planning.
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Affiliation(s)
- Young Seok Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Wan-Sun Choi
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hun Baek
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunwoo Kang
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Yang X, Zhang X, Ma X, Han M, Yu Y, Mi S. A new high-frequency ultrasound classification of De Quervain tenosynovitis. HAND SURGERY & REHABILITATION 2024; 43:101975. [PMID: 39486587 DOI: 10.1016/j.hansur.2024.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 10/15/2024] [Accepted: 10/17/2024] [Indexed: 11/04/2024]
Abstract
PURPOSE This study aimed to introduce a new high-frequency ultrasound classification of De Quervain tenosynovitis based on a large group of patients. Detailed characteristics of classification are also reported. METHODS From January 2014 to February 2024, patients diagnosed with De Quervain tenosynovitis were retrospectively reviewed. High-frequency ultrasound (7-14 MHz) scanning was performed to identify the anatomy of the extensor pollicis brevis and abductor pollicis longus tendons, presence of intertendinous septa, and pathologic changes. The affected wrist was compared to the contralateral wrist. RESULTS 453 patients were included: 65 male and 388 female; mean age, 46 ± 27 years (range, 24-65 years). Symptom duration was 14 ± 27 weeks. Disease types were type 0 (n = 5), type 1 (n = 195), type 2a (n = 72), type 2b (n = 18), type 2c (n = 50), type 3 (n = 59), type 4 (n = 45), and type 5 (n = 9). Mean retinacular thickness was 2.1 ± 0.5 mm in affected wrists and 0.4 ± 0.1 mm in contralateral wrists (p < 0.01). The intercompartmental septum was significantly thicker on the affected side (1.2 ± 0.7 mm) than on the asymptomatic side (0.1 ± 0.4 mm) (p < 0.01). CONCLUSIONS This novel classification provides detailed ultrasonographic characteristics of De Quervain tenosynovitis, based on a large population of patients. It may help in selecting treatment and predicting outcome. However, relevance and therapeutic significance remain to be demonstrated. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Affiliation(s)
- Xiaoliang Yang
- Hand Surgery Department, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei 050051, China
| | - Xu Zhang
- Hand Surgery Department, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei 050051, China
| | - Xiuqing Ma
- Ultrasonic Department, Fengrun People's Hospital, 456 Caoxueqin W Road, Fengrun District, Tangshan, Hebei 064000, China
| | - Mei Han
- Ultrasonic Department, Fengrun People's Hospital, 456 Caoxueqin W Road, Fengrun District, Tangshan, Hebei 064000, China
| | - Yadong Yu
- Hand Surgery Department, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei 050051, China
| | - Shijun Mi
- Ultrasonic Department, Fengrun People's Hospital, 456 Caoxueqin W Road, Fengrun District, Tangshan, Hebei 064000, China.
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Margalit A, Bookman J, Aversano M, Guss M, Ayalon O, Paksima N. De Quervain's Tenosynovitis Release With Excision of the First Dorsal Compartment: Novel Surgical Technique and a Case Series. Tech Hand Up Extrem Surg 2024; 28:197-200. [PMID: 38907611 DOI: 10.1097/bth.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.
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Affiliation(s)
- Adam Margalit
- Department of Orthopaedic Surgery, NYU School of Medicine NYU Langone Health, New York, NY
| | - Jared Bookman
- Department of Orthopaedic Surgery, NYU School of Medicine NYU Langone Health, New York, NY
| | | | - Michael Guss
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston
- Hand Surgery PC, Newton-Wellesley Hospital, Newton, MA
| | - Omri Ayalon
- Department of Orthopaedic Surgery, NYU School of Medicine NYU Langone Health, New York, NY
| | - Nader Paksima
- Department of Orthopaedic Surgery, NYU School of Medicine NYU Langone Health, New York, NY
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Suwannaphisit S, Panichnantho N, Fongsri W, Suwanno P. Transverse versus longitudinal skin incision in first extensor tendon release for radial styloid tenosynovitis: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:969. [PMID: 39604939 PMCID: PMC11603922 DOI: 10.1186/s12891-024-08037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND De Quervain's tenosynovitis, characterized by the entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first extensor compartment, leads to pain and swelling near the radial styloid. When conservative treatments including rest and antiinflammatory medications fail, surgery is often recommended. This study aimed to compare transverse and longitudinal skin incisions with respect to surgical scars, postoperative pain, and functional outcomes in the open release of the first extensor compartment in radial styloid tenosynovitis. METHODS Seventy patients were randomly assigned to either the transverse or longitudinal skin incision group using a computer-generated random number table. Postoperative scarring was assessed using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Patient-Rated Wrist Evaluation (PRWE) questionnaire at 2, 6, and 12 weeks post-surgery. Continuous data were presented as mean ± standard deviation for normally distributed data or as median (interquartile range) for skewed distributions. RESULTS Following surgery, both groups showed marked improvements in Thai PRWE and POSAS scores, with no differences in functional outcomes. The longitudinal incision group had significant pain reduction at 2 and 6 weeks post-surgery. By 12 weeks, pain alleviation was similar in both groups. Wound infection was not observed in any case, and three patients reported temporary paresthesia, which was not statistically significant between the groups. CONCLUSIONS Both techniques demonstrate similar improvements in functional scores and reductions in pain scores, with no significant differences in complication rates, particularly concerning hypertrophic scars. The decision between transverse and longitudinal skin incisions should consider the surgeon's expertise, the patient's anatomical characteristics, and the complexity of the surgical procedure. Each approach presents distinct trade-offs, highlighting the necessity of a personalized, patient-centered strategy to optimize surgical outcomes. TRIAL REGISTRATION The study was registered on 27/06/2023, at clinicaltrials.in.th (TCTR20230627001). This study was retrospectively registered.
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Affiliation(s)
- Sitthiphong Suwannaphisit
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok, 10300, Thailand
| | - Nipat Panichnantho
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok, 10300, Thailand
| | - Warangkana Fongsri
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Pormes Suwanno
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
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Thakker A, Johnson N, Dias J. Factors influencing surgical treatment of De Quervain's tendinopathy: A retrospective cross-sectional observational study. J Clin Orthop Trauma 2024; 58:102790. [PMID: 39564591 PMCID: PMC11570864 DOI: 10.1016/j.jcot.2024.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/13/2024] [Accepted: 10/28/2024] [Indexed: 11/21/2024] Open
Abstract
Background The literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited. Purpose We hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management. Methods This retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p < 0.05) were included in the logistic regression model, used to predict factors influencing surgical management. Results Bivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment. Conclusion This study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.
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Affiliation(s)
- Arjuna Thakker
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, United Kingdom
| | - Nicholas Johnson
- The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, United Kingdom
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Cho JY, Oh JC, Oh WT, Koh IH, Chun YM, Choi YR. Prediction of an intracompartmental septum and its effect on outcomes of endoscopic release for de Quervain's syndrome. J Hand Surg Eur Vol 2024; 49:878-884. [PMID: 37994009 DOI: 10.1177/17531934231214137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jae-Yong Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jin-Chul Oh
- Department of Orthopaedic Surgery, Ace Hospital, Ansan, Republic of Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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Morisaki S, Tsuchida S, Oda R, Takahashi K. Quantitative Analysis of Ultrasonography for de Quervain's Disease: Comparison of the Affected Side With the Asymptomatic Side. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1437-1443. [PMID: 36514245 DOI: 10.1002/jum.16152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The pathology of de Quervain's disease affects the tenosynovium and rarely the tendons. The ultrasonographic features of de Quervain's disease unresponsive to conservative treatment are unknown. The purpose of this study was to describe and compare the morphological differences between patients with de Quervain's disease that is refractory to conservative treatment and patients who respond to conservative treatment. METHODS de Quervain's disease unresponsive to conservative treatment was evaluated in 51 patients. The bilateral wrists underwent preoperative ultrasonographic assessments. The asymptomatic side was presumed to be the patient's anatomical baseline and was used for comparison. We measured the diameter and cross-sectional area of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), and the thickness of the tendon sheath and the intercompartmental septum, if present. The affected side and asymptomatic side were compared. RESULTS The APL and EPB cross-sectional area was significantly larger on the affected side than on the asymptomatic side (APL: 13 mm2 versus 8.3 mm2 ; P < .0001; EPB: 5.4 mm2 versus 3.9 mm2 ; P = .031). The tendon sheath was significantly thicker on the affected side (1.5 mm) than on the asymptomatic side (0.95 mm) (P < .0001). The intercompartmental septum was significantly thicker on the affected side (1.1 mm) than on the asymptomatic side (0.72 mm) (P = .0004). Operative findings revealed 41 (80%) patients had an intercompartmental septum. CONCLUSIONS The ultrasonographic features of de Quervain's disease requiring surgical treatment were a significantly thickened tendon sheath, an intercompartmental septum, and increased cross-sectional area of the APL and EPB.
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Affiliation(s)
| | - Shinji Tsuchida
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
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McBain B, Rio E, Cook J, Sanderson J, Docking S. Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial. HAND THERAPY 2023; 28:72-84. [PMID: 37904860 PMCID: PMC10584067 DOI: 10.1177/17589983231158499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/20/2023] [Indexed: 11/01/2023]
Abstract
Introduction de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Methods This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Results Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusions Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.
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Affiliation(s)
- Brodwen McBain
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- The Upper Limb Co, Melbourne, VIC, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | | | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
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Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus 2023; 15:e38079. [PMID: 37252462 PMCID: PMC10208847 DOI: 10.7759/cureus.38079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Since Fritz De Quervain first postulated stenosing tenosynovitis within the radial dorsum of the wrist, much research has been conducted to provide further insights. De Quervain's Disease (DQD) is a condition that affects the tendons that control the movement of the thumb, specifically the abductor pollicis longus and extensor pollicis brevis. Numerous studies have shown that structural divergence from normal anatomy is partly related to contingency for developing DQD. Even though this condition was discovered many years ago, its exact etiology remains a subject of debate. Two schools of thought exist, one that contends an inflammatory-mediated pathway and the other degenerative changes. Substantial evidence exists for both theories, thus necessitating further studies into the etiology of DQD. Classically, Finkelstein's and Eichhoff's tests have been used as the physical examinations of choice for clinically diagnosing this condition. However, these tests have been shown to have low specificity, hence, the emergence of the wrist hyperflexion and abduction of the thumb test. Evidence also suggests that ultrasonography may become a critical diagnostic tool, especially to identify anatomical variations before invasive treatment, reducing the risk of further complications. The management of DQD is typically conservative, with escalation to steroid injections before surgery is indicated. Future research into this disease should focus on establishing a clearer picture of how anatomical variations and other pathological and occupational factors may interplay to bring about this condition. While current research has suggested possible novel approaches for diagnosing and treating DQD, more studies are required to gain greater insights into the effectiveness of these interventions.
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Affiliation(s)
- Adegbenro O Fakoya
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Martin Tarzian
- Psychiatry, University of Medicine and Health Sciences, Basseterre, KNA
| | - Enrique L Sabater
- Anatomy, University of Medicine and Health Sciences, Basseterre, KNA
| | - Daiana M Burgos
- Anatomy, University of Medicine and Health Sciences, Basseterre, KNA
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Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023; 107:105-114. [PMID: 35195844 PMCID: PMC10020267 DOI: 10.1007/s12306-022-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.
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Affiliation(s)
| | | | - A M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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Surgical Treatment Outcome of de Quervain’s Disease: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open 2022; 10:e4305. [PMID: 35539295 PMCID: PMC9076451 DOI: 10.1097/gox.0000000000004305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
Background: Surgical release of the extensor retinaculum is performed as a treatment for de Quervain’s (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic review and meta-analysis were conducted. Methods: A systematic search was performed in Embase, Medline Ovid, Web of Science Core Collection, Cochrane, and Google Scholar. Articles regarding surgical treatment of DQ disease that reported outcome and complications were included. We extracted exact values of visual analog scale scores and percentages of patients who experienced pain at follow-up. Complications assessed were (sub) luxation, superficial radial nerve injuries, wound infections, and scar problems. Results: Twenty-one studies with a total of 939 patients were included. Five percent of these patients (95% CI 1%–18%) did not show complete remission of pain at follow-up. When pooled, the mean reduction in visual analog scale scores was 5.7 (95% CI 5.3–6.1) on a 0–10 scale. No difference in outcome between different types of surgery or incisions was seen. Based on the meta-analysis, the pooled complication rate was 11% (95% CI 5%–22%). Conclusions: Five percent of patients still have residual pain after surgical release of the first extensor compartment. Surgery type, as well as the type of incision, did not affect outcome or complication. Thus, surgical release of the extensor retinaculum for DQ disease is an effective treatment, regardless of the type of surgery.
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12
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Local steroid injection versus surgical release for treatment of persistent De Quervain’s stenosing tenosynovitis (DQST): a prospective comparative study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salim B, Ansari MT, Kumar VS, Goyal A, Malhotra R. Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial. J Wrist Surg 2021; 10:377-384. [PMID: 34631289 PMCID: PMC8489986 DOI: 10.1055/s-0041-1725171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/21/2021] [Indexed: 12/16/2022]
Abstract
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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Affiliation(s)
- Burhan Salim
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Larsen CG, Fitzgerald MJ, Nellans KW, Lane LB. Management of de Quervain Tenosynovitis: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202109000-00009. [PMID: 34506345 DOI: 10.2106/jbjs.rvw.21.00069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
» Most cases of de Quervain tenosynovitis can be managed with nonoperative measures, and the mainstay of treatment is corticosteroid injection (CSI). The use of ultrasound may improve the accuracy of injections and can help to identify and localize injections to separate subcompartments. » For patients who are in the third trimester of pregnancy or breastfeeding, there is no contraindication to CSI as studies have shown that it can provide optimal symptomatic relief to the mother without impacting the baby. » When nonoperative treatment is unsuccessful, surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief. Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy, resulting in fewer injuries to underlying structures and a lower incidence of hypertrophic scarring compared with a transverse incision. » For surgeons who are comfortable performing endoscopic techniques, endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury. » Studies have shown that FDC release can safely and effectively be performed using the WALANT (wide-awake local anesthesia no tourniquet) technique, which has the potential for cost savings without compromising quality or patient comfort.
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Affiliation(s)
- Christopher G Larsen
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
| | - Michael J Fitzgerald
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
| | - Kate W Nellans
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Lewis B Lane
- Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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15
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McCool L, Tonkin B, Guo D, Guo D, Senk A. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16:644-649. [PMID: 31540554 PMCID: PMC8461189 DOI: 10.1177/1558944719873435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
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Affiliation(s)
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Medical Center, MN, USA
| | | | | | - Alexander Senk
- Minneapolis Veterans Affairs Medical Center, MN, USA,Alexander Senk, Department of Physical Medicine & Rehabilitation, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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Stirling PHC, Robertson FM, McEachan JE. A comprehensive analysis of medium-term outcomes of open first dorsal compartment release for de Quervain's syndrome. HAND SURGERY & REHABILITATION 2020; 40:40-43. [PMID: 33099034 DOI: 10.1016/j.hansur.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/09/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
The primary aim of this study is to describe medium-term functional outcomes following first dorsal compartment decompression using a longitudinal incision in patients with de Quervain's syndrome. The secondary aims are to describe the improvement in health-related quality of life and patient satisfaction, and to determine the cost-effectiveness of this procedure. Pre- and postoperative QuickDASH, EQ-5D-5 L, and satisfaction scores were collected prospectively over five years. Paired data were available for 36 patients (90% at mean 32 months follow-up). The median QuickDASH score improved significantly from 50 to 9.1 (p < 0.01). Median EQ-5D-5L index scores improved from 0.65 preoperatively to 0.73 (p = 0.03). The satisfaction rate was 97% and there were no cases of superficial radial nerve injury or neuroma. The cost per quality-adjusted life year gained was £356 (€398; $449). First dorsal compartment release using a longitudinal incision results in a significant improvement in function, with high levels of patient satisfaction, and low complication rates. In addition, health economic analysis revealed that this is a cost-effective procedure for the treatment of de Quervain's syndrome. LEVEL OF EVIDENCE: III (cohort study).
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Affiliation(s)
- Paul H C Stirling
- Queen Margaret Hospital, Whitefield Road, Dunfermline, KY12 0SU, United Kingdom; Fife Virtual Hand Clinic, https://fifevirtualhandclinic.co.uk/.
| | | | - Jane E McEachan
- Queen Margaret Hospital, Whitefield Road, Dunfermline, KY12 0SU, United Kingdom; Fife Virtual Hand Clinic, https://fifevirtualhandclinic.co.uk/
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Stephens AR, Yu Z, Presson AP, Tyser AR, Kazmers NH. Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery. J Wrist Surg 2020; 9:289-297. [PMID: 32760607 PMCID: PMC7395842 DOI: 10.1055/s-0040-1708863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/13/2020] [Indexed: 12/26/2022]
Abstract
Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal-Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t -test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.
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Affiliation(s)
- Andrew R. Stephens
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Ziji Yu
- Division of Public Health, University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Division of Public Health, University of Utah, Salt Lake City, Utah
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah
| | - Andrew R. Tyser
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Nikolas H. Kazmers
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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18
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Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I. Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial. Hand (N Y) 2020; 15:215-219. [PMID: 30060681 PMCID: PMC7076607 DOI: 10.1177/1558944718791187] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: De Quervain tenosynovitis is commonly seen in patients who perform repetitive wrist ulnar deviation with thumb abduction and extension. Previous studies comparing nonsurgical options have contributed to a lack of consensus about ideal management. This study's purpose was to analyze results in prospectively randomized patients treated with either corticosteroid injection (CSI) alone versus CSI with immobilization. Methods: Radial sided wrist pain, first dorsal compartment tenderness, and positive Finkelstein test were used to define De Quervain. Pain score of 4 or higher on a visual analog scale (VAS) was utilized for inclusion. Following exclusion criteria, patients underwent randomization into groups: (1) CSI alone; or (2) CSI with 3 weeks of immobilization. We followed at 3 weeks and 6 months for further evaluation, where resolution of symptoms and improvements in VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed to evaluate treatment success. Results: Nine patients with CSI alone and 11 patients with CSI and immobilization were followed. At 6 months in both groups, patients experienced significant improvement in VAS and DASH scores, while 88% of patients with CSI alone and 73% of patients with CSI and immobilization experienced complete resolution of at least 2 out of 3 of their pretreatment symptoms. Between groups, outcomes were comparable except for resolution of radial-sided wrist pain, which was superior in patients with CSI alone (100% vs 64%). Conclusions: Immobilization following injection increases costs, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Further prospective studies are warranted.
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Affiliation(s)
- Joseph A. Ippolito
- Rutgers New Jersey Medical School, Newark, USA,Joseph A. Ippolito, Department of Orthopaedics, Rutgers New Jersey Medical School, 140 Bergen Street, Suite D-1610, Newark, NJ 07103, USA.
| | | | - Jay Patel
- Rutgers New Jersey Medical School, Newark, USA
| | | | - Irfan Ahmed
- Rutgers New Jersey Medical School, Newark, USA
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19
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Verma S, Agrawal A. Anatomical variation in the first extensor compartment during treatment of De Quervain'S tenosynovitis. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Blackburn J, van der Oest MJW, Selles RW, Chen NC, Feitz R, Vranceanu AM, Porsius JT. Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain's Tenosynovitis? A Cross-sectional Study. Clin Orthop Relat Res 2019; 477:2750-2758. [PMID: 31764346 PMCID: PMC6907288 DOI: 10.1097/corr.0000000000000992] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression, anxiety, and pain catastrophizing have been associated with worse pain and function in studies of patients with de Quervain's tenosynovitis. Illness perceptions are the patient's thoughts and feelings about their illness. More negative perceptions of the illness such as the illness having a long duration or serious consequences are associated with worse physical function in patients with hand osteoarthritis. It is currently unknown whether these psychological factors play a similar role in de Quervain's. We chose to study patients who have tried nonoperative management and have chosen surgical decompression due to persistent symptoms. Psychological factors may be associated with their ongoing pain and impaired function, so it is particularly important to investigate the role of psychosocial factors that may be targeted with non-invasive interventions. QUESTIONS/PURPOSES Which psychological variables are independently associated with baseline pain and function in patients undergoing surgical treatment for de Quervain's tenosynovitis, after controlling for clinical and demographic variables? METHODS This cross-sectional study included data from a longitudinally maintained database on 229 patients who had surgery for de Quervain's tenosynovitis between September 2017 and October 2018. All management options were discussed with patients, but many had already tried nonoperative management and chose surgery once referred to our institution. Our database included 958 patients with de Quervain's, with 69% (659) managed nonoperatively and 34% (326 of 958) who underwent surgical decompression. A total of 70% (229 of 958) completed all questionnaires and could be included in the study. With the numbers available, we found no differences between those included and those not analyzed in terms of age, gender, duration of symptoms, BMI, smoking status, and workload.Patients completed the Patient-Rated Wrist/Hand Evaluation (PRWHE), Patient Health Questionnaire for emotional distress, Pain Catastrophizing Scale (PCS), and the Brief Illness Perception Questionnaire. We investigated the relative contribution of patient demographics and individual psychosocial factors using a hierarchical multivariable linear regression model. In the first step we considered how demographic factors were associated with the baseline PRWHE score. In the second step we investigated the effect of pain catastrophizing and emotional distress on the baseline PRWHE score after accounting for confounding demographic factors. In the final step, the effect of illness perceptions on baseline PRWHE were considered after accounting for the confounding effects of demographic factors as well as pain catastrophizing and emotional distress. RESULTS After controlling for confounding variables including workload and emotional distress, a more negative patient perception of the consequences of their condition and worse pain catastrophizing were associated with worse pain and function (consequences, β = 0.31; p < 0.01, pain catastrophizing β = 0.17; p = 0.03). A hierarchical multivariable regression analysis found that 11% of variance in baseline pain and function was explained by pain catastrophizing and emotional distress. Illness perceptions brought the total explained variance of the final model to 34%. CONCLUSIONS More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. In light of these findings, future studies might explore interventions to reduce pain catastrophizing and lower the perceived consequences of the condition. This may reduce the number of patients choosing surgical decompression or may also improve surgical outcomes. Further work should consider if these psychological factors are also associated with postoperative patient-reported outcomes. LEVEL OF EVIDENCE LEVEL III, therapeutic study.
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Affiliation(s)
- Julia Blackburn
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA J. Blackburn, M. J. W. van der Oest, A-M. Vranceanu, J. T. Porsius, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
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Kim JH, Yang SW, Ham HJ, Kim JP. Tendon Subluxation After Surgical Release of the First Dorsal Compartment in De Quervain Disease. Ann Plast Surg 2019; 82:628-635. [PMID: 31082847 DOI: 10.1097/sap.0000000000001860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We aimed to determine whether dorsoulnar incision elevating radial flap and immobilization for the treatment of de Quervain disease have an advantage over simple midline incision and early mobilization, respectively, in terms of tendon subluxation and clinical outcomes. Forty-six patients with de Quervain disease were randomly divided into 2 groups (midline incision vs dorsoulnar incision) and 2 subgroups (immobilization vs early mobilization). Subluxation of intracompartmental tendons was measured in dynamic wrist positions at 12 and 24 weeks using ultrasonography. The DASH (Disabilities of the Arm, Shoulder, and Hand) and visual analog scale scores and grip and pinch strengths were evaluated. At 24 weeks, the tendons were displaced voloradially in wrist volar flexion (1.25 mm in midline incision vs 0.36 mm in dorsoulnar incision, P = 0.001), whereas the tendons were displaced dorsoulnarly in wrist extension (0.95 mm in midline incision vs 1.78 mm in dorsoulnar incision, P = 0.041). There were no significant differences in tendon displacement between early mobilization and immobilization groups. Clinical outcome measures showed no variation between the groups, and no significant correlation occurred with tendon subluxation. Dorsoulnar incision and postoperative immobilization do not have advantage over midline incision and early mobilization, respectively. However, tendon subluxation after release of the first dorsal compartment for de Quervain disease does not affect clinical outcomes.
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Affiliation(s)
- Ji-Hyo Kim
- From the Department of Career Education, College of General Education
| | - Seog-Won Yang
- Department of Orthopedic Surgery, College of Medicine, and
| | - Hee-Jeong Ham
- Department of Orthopedic Surgery, College of Medicine, and
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Kim JY, Baek JH, Lee JH. Comparison between simple release and Z-plasty of retinaculum for de Quervain's disease: a retrospective study. J Hand Surg Eur Vol 2019; 44:390-393. [PMID: 30669923 DOI: 10.1177/1753193418818341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Jin-Young Kim
- Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul Korea
| | - Jong-Hun Baek
- Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul Korea
| | - Jae-Hoon Lee
- Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul Korea
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Ravi PK, Tewari J, Mishra PR, Tripathy SK, Nanda SN, Gantaguru A. Variations of extensor pollicis brevis tendon in Indian population: A cadaveric study and review of literature. J Clin Orthop Trauma 2019; 10:278-281. [PMID: 30828193 PMCID: PMC6383140 DOI: 10.1016/j.jcot.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Variations of the tendons of the first dorsal compartment of the wrist may be one of reasons of treatment failure and recurrence in De Quervain's tenosynovitis (DQT). The present cadaveric study was designed to look into the variations of the Extensor pollicis brevis (EPB) tendon in Indian population. METHODS Seventy-seven formaldehyde-fixed cadaveric upper limbs of Indian origins were dissected to observe the number of EPB tendons and its variations. RESULTS The EPB muscle was found to be absent in one hand (1.3%). The EPB muscle was found with single tendon, two tendons and three tendons in 73 limbs (94.8%), 2 limbs (2.6%) and one limb (1.3%) respectively. The muscle originated from the posterior surface of the radius and the adjacent interosseous membrane. The EPB muscle with single tendon was found to be inserted into the distal part of dorsal surface of the proximal phalanx of the thumb in 44 limbs (57.1%). In limbs with bitendinous EPB, the tendon slips were inserted into the base of proximal phalanx and into the base of distal phalanx of the thumb. An Osseo-fibrous septum separating EPB from Abductor Pollicis Longus (APL) was observed in 45 limbs (58%). CONCLUSION EPB in first extensor compartment of Indians is usually monotendinous. It mostly inserts into the distal part of dorsal surface of proximal phalanx of thumb and into the base of distal phalanx. In majority of the wrists, one may find an osseofibrous ridge separating EPB from APL. These anatomical variations may be helpful to guide proper treatment in de Quervain's tenosynovitis.
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Affiliation(s)
- Praveen Kumar Ravi
- Dept. of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jerina Tewari
- Department of Anatomy, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | | | - Sujit Kumar Tripathy
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Narayan Nanda
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Amrit Gantaguru
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
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Karakaplan M, Ertem K, Canbay A, Aslantürk O, Yoloğlu S. One portal endoscopic release of the first extensor compartment in de Quervain's disease. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:40-44. [PMID: 30409393 PMCID: PMC6424652 DOI: 10.1016/j.aott.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 07/17/2018] [Accepted: 10/08/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. MATERIALS AND METHODS The patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. RESULTS The mean operating time was 13.9 min (range, 10-21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. CONCLUSIONS One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. LEVEL OF EVIDENCE Level IV Therapeutic Study.
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Affiliation(s)
- Mustafa Karakaplan
- Orthopaedics and Traumatology Department, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey.
| | - Kadir Ertem
- Orthopaedics and Traumatology Department, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey
| | - Ali Canbay
- Orthopaedics and Traumatology Department, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey
| | - Okan Aslantürk
- Orthopaedics and Traumatology Department, Malatya Education and Research Hospital, Malatya, Turkey
| | - Saim Yoloğlu
- Department of Statistics, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey
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Awan WA, Babur MN, Masood T. Effectiveness of therapeutic ultrasound with or without thumb spica splint in the management of De Quervain's disease. J Back Musculoskelet Rehabil 2018; 30:691-697. [PMID: 28035912 DOI: 10.3233/bmr-160591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The management of De Quervain's disease is determined more by Intuition than scientific data. The choice of first line conservative option for the management of De Quervain's disease is still a topic of debate. AIM To evaluate the effectiveness of therapeutic ultrasound with or without spica splint in the management of De Quervain's disease (DQD). DESIGN Randomized controlled trial (RCT). SETTING Outpatient department of Al-Nafees Medical College Hospital, Islamabad, Pakistan. POPULATION Thirty patients who had the history of the De Quervain's disease for at least 6 months were enrolled in the study. The ages of the patient were 30-50 year. The population included housewives, maids, painters, and teachers. METHODS Thirty patients were divided into two groups. The control group was treated with therapeutic ultrasound while in the experimental group thumb spica splitting was also added. The data was collected from the subjects through Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The demographic data was presented in the form of tables. Intervention-induced changes within the groups were investigated using paired sample t-test while independent sample t-test was used to compare the two groups. RESULTS Significant changes within both groups (p ≤ 0.05) were observed as a result of intervention. Additionally, significant differences in some instrument items were found between experimental and control group (p ≤ 0.05) after intervention. However, some items did not demonstrate significant changes in both groups likely because there was no effect of De Quervain's disease on those items before the intervention. CONCLUSION The results showed that the use of therapeutic ultrasound and spica splint together is more effective than using therapeutic ultrasound alone in the conservative management of De Quervain's disease. CLINICAL REHABILITATION IMPACT This study provides evidence to the relevant clinicians and professionals on the utility of therapeutic ultrasound combined with thumb spica splint in the conservative management of DQD.
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Ceylan H, Kaya O, Caypinar B, Ozturk M. Factors effecting the success of conservative management in de Quervain cases. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.382440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Poublon AR, Kleinrensink GJ, Kerver ALA, Coert JH, Walbeehm ET. Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study. World J Orthop 2018; 9:7-13. [PMID: 29468135 PMCID: PMC5807885 DOI: 10.5312/wjo.v9.i2.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/06/2018] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).
METHODS Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.
RESULTS This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.
CONCLUSION CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.
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Affiliation(s)
- Alexander R Poublon
- Department of Neuroscience and Anatomy, Erasmus MC, Rotterdam, Zuid-Holland 3000 CA, Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience and Anatomy, Erasmus MC, Rotterdam, Zuid-Holland 3000 CA, Netherlands
| | - Anton LA Kerver
- Department of Plastic and Reconstructive surgery, Catharina Ziekenhuis, Eindhoven, Noord-Brabant 5623 EJ, Netherlands
| | - J Henk Coert
- Department of Plastic Surgery, UMC Utrecht, Utrecht, Utrecht 3584 CX, Netherlands
| | - Erik T Walbeehm
- Department of Plastic Surgery, Radboud UMC, Gelderland, Nijmegen 6500 HB, Netherlands
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Allam AES, Al-Ashkar DS, Negm AA, Eltawab BA, Wu WT, Chang KV. Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon? J Pain Res 2017; 10:2299-2302. [PMID: 29026332 PMCID: PMC5627726 DOI: 10.2147/jpr.s143256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
De Quervain disease (DQVD) is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times). After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist.
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Affiliation(s)
- Abdallah El-Sayed Allam
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa Shawky Al-Ashkar
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed A Negm
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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