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First Extensor Compartment Release for de Quervain's Tenosynovitis

March 01, 2017

Contributors: Amos Dai, BS; Mikael Starecki, MD; Nader Paksima, DO; Nader Paksima, DO

Purpose: Occasionally, the abductor pollicis longus and the extensor pollicis brevis exist in separate subsheaths. This results in repeated abduction of the thumb and ulnar deviation at the wrist, creating friction at the sheath and swelling of the fibro-osseous canal. This condition is called de Quervain tenosynovitis. This video demonstrates first extensor compartment release for the management of de Quervain tenosynovitis. Methods: The video discusses the case presentation of a 45-year-old woman who has experienced pain and swelling at the radial styloid for 4 months. Three attempts at nonsurgical treatment, including two steroid injections and thumb spica splinting, failed in the patient. On physical examination, the patient has tenderness to palpation at the radial styloid and a positive Finkelstein test. The patient elected to undergo surgical release of the first extensor compartment. The radial styloid, the abductor pollicis longus, and the extensor pollicis brevis are identified as landmarks, after which a transverse incision is made to the localized area. After the superficial radial nerve is protected and the distal edge of the first dorsal compartment is identified, distal tenosynovectomy is performed to clearly identify and separate the subsheath between the abductor pollicis longus and the extensor pollicis brevis. The subsheath is released, and the entire volar rim is excised off the bone, allowing the tendons to move freely and avoid subluxation. Any remaining bony protuberance on the volar rim or central or dorsal ridge separating the tendons is excised. Traction of both tendons is assessed before wound closure. Results: Postoperatively, the patient is placed in a soft dressing. She is allowed to begin gentle range of motion exercises on the first postoperative day. The outcomes of this procedure are excellent, with more than 91% of patients reporting no complications. Potential complications of the procedure include incomplete release, neuroma, and injury to the superficial branch of the radial nerve. Conclusion: At the end of the video, we demonstrate first extensor compartment release for the management of de Quervain tenosynovitis. Surgical management of de Quervain tenosynovitis via first extensor compartment release results in minimal complications and great outcomes for patients with physical indications in whom nonsurgical treatment has been attempted.

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