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J Wrist Surg
DOI: 10.1055/a-2662-1374
Scientific Article

Can Hyaluronic Acid Reduce Friction in the First Extensor Compartment? A Cadaveric Study

Authors

  • Gilad Rotem 

    1   University of Western Ontario, Roth McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
    2   Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Ontario, Canada
    3   Department of Hand Surgery, Sheba Medical Center, Tel Aviv University School of Medicine, Tel Hashomer, Israel

  • Emma Badowski

    1   University of Western Ontario, Roth McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
    4   Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada

  • Matan J Cohen

    5   Clalit Health Services, Affiliated with the Hebrew University Faculty of Medicine, Jerusalem District, Jerusalem, Israel

  • G. Daniel G Langohr

    1   University of Western Ontario, Roth McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
    4   Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada

  • Assaf Kadar

    1   University of Western Ontario, Roth McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
    2   Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Ontario, Canada

Funding This work was supported by the NSERC Discovery Grant Program; the Western University Department of Surgery Internal Research Fund; the Western University Bone and Joint Institute Catalyst Grant; and the Academic Medical Organization of Southwest Ontario (AMOSO) opportunity grant.
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Abstract

Objective

De Quervain's tenosynovitis (DQT), marked by pain and dysfunction from thickening of the first dorsal compartment, traditionally relies on treatments like corticosteroid injections, physiotherapy, braces, and surgery. This study explores hyaluronic acid (HA), recognized for its lubricating properties, as a nonsurgical alternative to improve tendon gliding at the tendon–retinaculum interface.

Study Design

Biomechanical cadaveric study.

Materials and Methods

Eighteen cadaveric specimens of the first extensor tendon compartment were soaked in saline. Half were treated with HA and half with celestone soluspan. Friction between the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons against the extensor retinaculum was measured at wrist–thumb angles of 30 to 20 degrees and 30 to 0 degrees.

Results

HA significantly reduced friction by 18.7% compared with saline, with the greatest reduction observed in the EPB at the 30 to 20-degree angle.

Conclusion

These findings indicate that HA may offer a promising nonsurgical treatment for DQT and support further clinical trials.

Level of Evidence III.

Keywords

friction testing - gliding resistance - hyaluronic acid - De Quervain's tenosynovitis - corticosteroid - biomechanical - extensor tendons - hand surgery

Authors' Contributions

G.R.: Initiated the study, data collection, data analysis, and writing of the manuscript.


E.B.: Established the mechanical model, data collection, and data analysis.


D.L.: Establishment of the mechanical model and data analysis.


A.K.: Initiated the study, established the mechanical model, reviewed, and provided guidance.


M.C.: Statistical analysis.




Publication History

Received: 25 November 2024

Accepted: 21 July 2025

Article published online:
12 August 2025

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