De Quervain’s release – Dorsal approach
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This is a detailed step by step instruction through a release of the 1st Extensor compartment for a diagnosis of De Quervain’s tenosynovitis.
In 1895 Fritz de Quervain repaorted 5 cases of painful thickened first dorsal compartment of the wrist.
De Quervain’s is a non-inflammatory stenosing tenovaginitis which is often self-limiting with activity modification. The fibro-osseous tunnel or contents of the 1st extensor compartment, namely the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons, become thickened causing pain and possible crepitus and catching during thumb movements.
This decompression procedure is undertaken when all non-operative treatment options – activity modification, analgesia, steroid injection, splintage, physiotherapy – have been exhausted.
The surgery is very successful however it can have 2 very significant complications which create more pain and dysfunction then the original complaint and are much more difficult to resolve. These complications are volar subluxation of tendon in wrist flexion and neuropathic pain from the superficial radial nerve or lateral cutaneous nerve of the forearm branches.
Following surgery patients are put into a bulky bandage and allowed to mobilise however no heavy lifting, twisting or gripping for 6 weeks is advised.
Author:Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.