Biomechanical assessment of the first dorsal compartment of the wrist: A fresh cadaver study with relevance to de Quervain's disease.

Abstract

Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment. This study aimed to investigate the relationship between intertendinous septum's presence or absence, internal pressure and wrist positon in the first compartment. Fourteen arms were obtained from seven fresh frozen cadavers. A pressure sensor was inserted into the first compartment; if a septum was present, the pressure sensor was inserted into the abductor pollicis longus (APL) side and the extensor pollicis brevis (EPB) side, respectively. Three wrist positions were also tested: neutral, 45° flexion, and 45° extension. Intertendinous septa were present in seven wrists. The average pressure change in the first compartment measured on the EPB side of a present septum was significantly greater than that measured on the APL side of a present septum or where no septum existed: no septum=54.6 ± 48.3kPa; septum, EPB=81.7 ± 76.5kPa; and septum, APL=32.8 ± 37.4kPa. The average pressure change was also significantly greater in the flexion wrist position relative to the neutral and extension positions: neutral=36.3 ± 58.0kPa; 45° flexion=79.5 ± 65.9kPa; and 45° extension=50.4 ± 42.6kPa. Clear relationships existed between (1) the presence of a septum and increased internal pressure on the EPB side in the first compartment and (2) increased internal pressure with the wrist at 45° flexion compared with the neutral and extension position.