de Quervain Disease: US Identification of Anatomic Variations in the First Extensor Compartment with an Emphasis on Subcompartmentalization

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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Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2016.08.020 ◽

2017 ◽

Vol 70 (1) ◽

pp. 127-131 ◽

Cited By ~ 15

Author(s):

Z-Hye Lee ◽

J.T. Stranix ◽

Lavinia Anzai ◽

Sheel Sharma

Keyword(s):

Systematic Review ◽

Surgical Anatomy ◽

First Extensor Compartment ◽

De Quervain ◽

Extensor Compartment

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Anatomic Variations of the First Extensor Compartment and Abductor Pollicis Longus Tendon in Trapeziometacarpal Arthritis

Hand ◽

10.1007/s11552-009-9234-3 ◽

2009 ◽

Vol 5 (2) ◽

pp. 184-189 ◽

Cited By ~ 3

Author(s):

Razvan C. Opreanu ◽

John Wechter ◽

Hazem Tabbaa ◽

John P. Kepros ◽

Michelle Baulch ◽

...

Keyword(s):

Anatomic Variations ◽

Longus Tendon ◽

Abductor Pollicis Longus ◽

First Extensor Compartment ◽

Extensor Compartment

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Omega “Ω” Pulley Plasty for Surgical Management of DeQuervain’s Disease

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500169 ◽

2018 ◽

Vol 23 (02) ◽

pp. 170-175 ◽

Cited By ~ 4

Author(s):

Joseph Bakhach ◽

Bachar Chaya ◽

Nazareth Papazian

Keyword(s):

Clinical Trial ◽

Adhesion Formation ◽

Styloid Process ◽

Alternative Procedure ◽

Periosteal Flap ◽

Extensor Tendons ◽

First Extensor Compartment ◽

De Quervain ◽

Extensor Compartment ◽

Surgical Option

Background: DeQuervain tenosynovitis, refractory to medical conservative treatment, has been traditionally treated by a simple division of the pulley, a procedure associated with several complications. Many authors attempted to prevent these complications by describing techniques of pulley reconstruction after its release necessitating suturing the different flaps and subsequently promoting extensor tendons adhesions. The authors present an alternative procedure for the first extensor compartment pulley decompression: “Omegaplasty”. Methods: 25 Patients with 29 DeQuervain tenosynovitis cases were enrolled in a prospective, nonrandomized clinical trial from 2012 to 2016. At enrollment they were offered the option of Omegaplasty as a surgical treatment modality for their cases. The procedure is based on liberating the anterior attachment of the pulley from the anterior lip of the styloïd process while respecting its continuity with the periosteal flap as well as promoting expansion of the tunnel volume. All operated patients were evaluated using the “Opposition Kapandji Score”. Results: The authors present the results of 29 different “Omegaplasty” procedures. Based on the Kapandji opposition score, twenty cases scored 10/10 while the remaining nine cases yielded an 8/10 score each. Conclusions: The described technique is simple, reliable and respects the extensor tendons gliding physiology and biodynamics. By preserving the anatomical continuity of the first extensor compartment pulley at the wrist, the risk of adhesion formation is reduced. The preliminary results are encouraging and provide the “Ω” plasty the potential to be considered as a surgical option for treatment of De Quervain Tenosynovitis.

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De Quervain`s disease: evaluation by high resolution ultrasonography

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173989 ◽

2017 ◽

Vol 5 (9) ◽

pp. 4093

Author(s):

Abhishek Das ◽

Prabhu B. J.

Keyword(s):

High Resolution ◽

Common Finding ◽

Extensor Retinaculum ◽

De Quervain’S Tenosynovitis ◽

First Extensor Compartment ◽

De Quervain ◽

Extensor Compartment ◽

High Resolution Ultrasonography ◽

A Prospective Study

Background: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first extensor compartment of wrist and leads to wrist pain and impaired function of wrist and hand. The aim of this study is to evaluate the role of high resolution ultrasonography in diagnosing suspected cases of de Quervain’s tenosynovitis and also to evaluate the role of high resolution ultrasonography in detecting the anatomical variants of the first extensor compartment which are predisposing conditions for de Quervain’s tenosynovitis.Methods: A prospective study of 15 consecutive cases who were referred with clinical diagnosis of de Quervain`s disease was done with ultrasonography in the department of Radio-diagnosis and findings were carefully analysed.Results: Thickened extensor retinaculum over the first extensor compartment was found in all the cases. Mean thickness of the thickened retinaculum is 1.65 mm. In 60% of cases multiple slips of APL tendon were found.Conclusions: From the study, we conclude that extensor retinaculum thickening is a common finding in de Quervain`s disease.

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De Quervain’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0277 ◽

2000 ◽

Vol 25 (1) ◽

pp. 65-69 ◽

Cited By ~ 35

Author(s):

N. R. M. KAY

Keyword(s):

De Quervain’S Disease ◽

Factors Associated ◽

The Poor ◽

First Extensor Compartment ◽

Extensor Compartment

The basic anatomy of the first extensor compartment is presented with a review of the pathology of de Quervain’s stenosing tenovaginitis. The results in 100 medicolegal cases of de Quervain’s disease are analysed and reasons are sought for the poor results. A review of the known factors associated with the causation of de Quervain’s disease is presented with recommendations about the management of this condition.

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Clinical Sign for Missed Decompression of a Separate Extensor Pollicis Brevis Compartment in de Quervain’s Disease

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/s-0043-105497 ◽

2017 ◽

Vol 49 (03) ◽

pp. 185-187

Author(s):

Niels Benatar

Keyword(s):

Clinical Sign ◽

Revisional Surgery ◽

Persistent Pain ◽

Previous Surgery ◽

De Quervain’S Disease ◽

Longus Tendon ◽

Abductor Pollicis Longus ◽

Extensor Pollicis Brevis ◽

First Extensor Compartment ◽

Extensor Compartment

AbstractPersistent pain despite previous surgery for de Quervain’s disease might be due to an overlooked septum between the abductor pollicis longus tendon slips and the extensor pollicis brevis tendon, or an overlooked completely separate compartment for the extensor pollicis brevis tendon alone. In both of these instances, extension of the MP joint of the thumb against resistance elicits pain at the distal level of the first extensor compartment of the wrist. When this sign is positive, revisional surgery and decompression of the remaining septum or separate compartment is indicated.

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