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De Quervain’s release – Dorsal approach surgical technique

Overview

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Learn the De Quervain’s release – Dorsal approach surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the De Quervain’s release – Dorsal approach surgical procedure.

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.

Feedback

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
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  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
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  • The course is completed once all the lessons are read and quizzes submitted and passed.
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  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity

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