[Surgical treatment in De Quervain's tenosynovitis. About 20 cases]

Effectiveness of surgical interventions for treating de Quervain's disease: A systematic review and meta-analysis

Introduction

This systematic review of randomized controlled trials was undertaken to assess whether any of the various currently used surgical interventions have better functional outcomes and less impairment or fewer surgical complications compared to the other common surgical interventions in de Quervain's disease.

Material and methods

Relevant studies related to surgical interventions in de Quervain's disease based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were identified from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing surgical interventions in de Quervain's disease published from January 2000 to December 2020. Functional outcome and impairment were the primary outcomes assessed.

Results

Three trials met the eligibility criteria which were following randomized controlled trial or quasi-experimental trial enrolling adults ≥18 years of age diagnosed with de Quervain's disease, comparing clinical outcomes between different surgical interventions, and including functional outcomes, impairment, pain and complications data. The Cochrane Risk of Bias Assessment Tool and GRADE approach were used to ascertain methodological quality. Statistical heterogeneity was tested with I-square and chi-square tests. The longitudinal skin incision probably slightly reduced superficial radial nerve injury, vein injury, scar hypertrophy, and total complications compared with the transverse skin incision with relative risk: 0.14, very low certainty by GRADE; 0.10, very low certainty by GRADE; 0.57, very low certainty by GRADE; and 0.23, very low certainty by GRADE, respectively.

Conclusion

Concerning the analysis of functional and pain scores, no significant results were able to be concluded. This study's findings must be considered in the light of quality and sample size limitations, and further high quality prospective randomized controlled clinical trials are needed to draw more firm conclusions.

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There has a various surgical treatment for radial styloid tenosynovitis. If the surgeon known the update evidence in each method will help them to deal with patient diagnosed radial styloid tenosynovitis.

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The current systematic and meta-analysis review depicted the evidence surgical options in terms of effectiveness and complications.

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This study's findings must be considered in the light of quality and sample size limitations, and further high quality prospective randomized controlled clinical trials are needed to draw more firm conclusions.

Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study

AIM

To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).

METHODS

Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.

RESULTS

This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.

CONCLUSION

CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

Outcome of longitudinal versus transverse incision in de Quervain's disease and its implications in Indian population

BACKGROUND

de Quervain's disease is an inadequacy into the first extensor compartment of wrist between the osteofibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons in first dorsal extensor compartment of the wrist.

AIM

(1) To compare the clinical results obtained by longitudinal and transverse incisions and (2) the implication of clinical results in Indian population.

MATERIALS AND METHODS

This study was conducted at Kalpana Chawla Government Medical College, Karnal, Haryana. The inclusion criteria were positive Finkelstein's test and no response to non-surgical treatment for 6 weeks. Forty-eight patients with de Quervain's disease who did not respond to conservative treatment were operated with two different incisions. The patients were followed at 6 weeks, 3 and 6 months to compare the surgical outcomes.

RESULTS

During a three-month follow-up, a significant difference was shown between the two methods (p = 0.0001). Results of surgical treatment with longitudinal incision were better (only one hypertrophic scar), but there were 12 postoperative complications with transverse incision. Visual analog scale (VAS) was used to evaluate the hypertrophic scar. In transverse incision group, out of five patients, four patients who developed hypertrophic scar have poor score according to VAS.

CONCLUSION

Overall, longitudinal incision should be used for surgical treatment for de Quervain's disease due to lower risk of complications.

The relationship of the superficial radial nerve and its branch to the thumb to the first extensor compartment

PURPOSE

The superficial radial nerve and its branches are vulnerable during surgery for de Quervain tenovaginitis. We studied the proximity of the nerve branches to the first extensor compartment.

METHODS

We dissected 20 forearms of 11 cadavers and measured the branching point of the superficial radial nerve relative to the radial styloid. We defined the midline of the first extensor compartment and measured distances of nerves adjacent to it.

RESULTS

The superficial radial nerve gave the lateral dorsal digital branch to the thumb at 50 ± 13 mm (minimum, 26 mm; maximum, 72 mm) proximal to the radial styloid. Average distances of the lateral dorsal digital branch to the thumb to the midline of first extensor compartment from proximal to distal were 2, 2, and 2 mm, respectively. In 8 forearms, the lateral dorsal digital branch to the thumb passed directly over the first extensor compartment along its entire length. We found that as the superficial radial nerve diverged from the first extensor compartment, its lateral dorsal digital branch to the thumb coursed parallel and in close relation to it.

CONCLUSIONS

Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury.

CLINICAL RELEVANCE

The close relation of the superficial radial nerve and its lateral dorsal digital branch to the thumb with the first extensor compartment may guide surgeons during surgery for de Quervain tenovaginitis.

De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey

BACKGROUND

Several operative methods have been described for de Quervain's disease, but no definite consensus has emerged in the literature. Sometimes simple release of the extensor retinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of the extensor retinaculum can cause volar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons. In this prospective study, we evaluated the early results of operative treatment with one-quarter partial resection of the extensor retinaculum when conservative methods have failed.

HYPOTHESIS

We hypothesized that partial removal of the extensor retinaculum may be used as an alternative to solve problems such as incomplete release or re-adhesion and volar subluxation of the tendons.

PATIENTS AND METHODS

Thirty-four patients (36 hands; 30 females and four males; mean age: 48.2 years; range: 20 to 75 years) with de Quervain's disease were surgically treated. The surgical procedure was performed under local infiltration anesthesia. One-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist was performed. During the clinical follow-up period, treatment results, a patient-based scoring system and visual analogue scale were used. The mean follow-up duration was 23.7 months (range: 12 to 71 months).

RESULTS

Two patients with wound infections were treated with adapted antibiotics. All patients were relieved of their symptoms; no triggering, recurrence or volar subluxation of the tendons of abductor pollicis longus or extensor pollicis brevis occurred. With this partial resection technique and according to a treatment scoring system described by Sawaizumi et al., 23 hands had excellent results, 11 hands had good results, and two hands had fair results; no hand exhibited a poor result. The mean visual analogue scale score was 1.8 (range: 0-6).

DISCUSSION

Our results showed that one-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist can be safely used for the operative treatment of de Quervain's disease with satisfactory short-term clinical results and no serious complications.

LEVEL OF EVIDENCE

Level IV: low-power prospective study.