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

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%).

Anatomical variations in the first dorsal compartment of the wrist: meta-analysis

“…Our results differ from previous major studies regarding prevalence of all APL variations [3,8,25,37,42,68]. Our results shows that mostly occurs the double-tendon APL variety with its 43.45% prevalence overall, 46.04% prevalence in cadavers and 45.33% prevalence in patients with de Quervain's disease.…”

“…In contrast of APL, EPB dominates with its single-tendon variety, both in cadavers and in patients with de Quervain's disease. Our results differ from previous major studies regarding prevalence of all EPB variations [3,8,25,37,42,50,68]. Comparing other varieties of EPB in both groups, it can also be accompted, that there are no statistically significant differences between cadavers and patients with de Quervain's disease, when it comes to anatomical variations of EPB in the first dorsal compartment (p > 0.05).…”

“…The quantity of EPB tendons in the first dorsal compartment of the wrist in patients with de Quervain's disease was examined in 9 studies [3,5,12,25,31,40,42,63,68] including 608 wrists. Number of EPB tendons varied from zero to three.…”

“…However, many studies have showed multiple anatomical variations in the first dorsal compartment. Most frequently reported anomalies are multiple APL tendons, multiple EPB tendons and the presence of the intercompartmental fibro-osseus septum [3,8,25,42,50]. Unfortunately, studies describing those variations are not consistent.…”

Back to the roots of rheumatology – Imaging of regional pain syndromes

“…6) or combined abnormalities affecting the EPB and the APL tendons were observed in a similar percentage. In 78% of cases, the APL tendon exhibited multiple tendon slips (range: 1e4) [45]. SWE was also used to identify the increased stiffness of tendons and their sheath in 40 patients with DQD symptoms in comparison with 40 healthy subjects.…”