Jnl 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
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Jack G. Graham
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Kevin F. Lutsky
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
T. Robert Takei
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Gregory G. Gallant
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Pedro K. Beredjiklian
1  Division of Hand Surgery, Department of Orthopedic Surgery, The Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations
Funding None.
Further Information

Publication History

02 October 2018

25 March 2019

Publication Date:
09 May 2019 (eFirst)

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%).

Ethical Approval

This study was approved by our Institutional Review Board.