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.
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Question 1 of 15
Which ONE of these options describes a tendon contained within the first Extensor compartment?CorrectIncorrect
Question 2 of 15
Which ONE option describes the pathology of De Quervain’s?CorrectIncorrect
Question 3 of 15
Which ONE option is not a differential diagnosis for De Quervain’s?CorrectIncorrect
Question 4 of 15
Which ONE of these options describes the non-operative treatments for De Quervain’s?CorrectIncorrect
Question 5 of 15
Whichi ONE of these conditions can be associated with De Quervains?CorrectIncorrect
Question 6 of 15
Which ONE OF these descriptions describes Finklestein’s test for De Quervain’s?CorrectIncorrect
Question 7 of 15
Which ONE of these options describes a possible underlying causative condition for De Quervain’s?CorrectIncorrect
Question 8 of 15
Which ONE assessment or investigation is least likely to yield useful information in De Quervain’s?CorrectIncorrect
Question 9 of 15
Which ONE option describes the nerve whosee nerve branches are most likely to be found within the operative field?CorrectIncorrect
Question 10 of 15
Which ONE option describes the operative step taken to reduce risk of volar subluxation of the APL and EPB tendons post operatively?CorrectIncorrect
Question 11 of 15
Which ONE of the options describes the cause of nerve injuries during De Quervain’s surgery?CorrectIncorrect
Question 12 of 15
Which ONE of these options describes the recurrence rate of De Quervains at 3 years?CorrectIncorrect
Question 13 of 15
Which ONE option describes the nerve injury rate during the procedure?CorrectIncorrect
Question 14 of 15
Which ONE of these describes the uncomplicated success rate for De Quervain’s surgical release?CorrectIncorrect
Question 15 of 15
Which ONE option describes the most effective treatment modalitie(s) for De Quervain’s?CorrectIncorrect