Failure of Surgical Treatment in the De Quervain Tenosynovitis

Abstract

Background: The De Quervain tenosynovitis is a rather common “easy to treat” syndrome. The majority of patients are successfully treated with conservative treatment. If the symptoms persist, the surgical release of the first dorsal compartment of the wrist usually definitively solves the problems. Sometimes, we observe patients whose problems are not solved by the surgical treatment. Aim: Our aim was to analyze the failed surgically treated cases selecting those patients whose symptoms did not disappear after a surgical treatment and find out the reason for the failure. Patients and Methods: We analyzed the last 9 years looking for those patients who returned with the persistence or the reappearance of the same symptoms like before the operation. We analyzed the intraoperative findings of the first operation, the clinical examination, and the applied treatment. In case of second operation, we analyzed the results of this. Results: In the period of 2007-2015, we found a total of 42 patients with unsuccessful operations for the De Quervain tenosynovitis. Careful clinical examination demonstrated in 7 cases the presence of a Wartenberg syndrome. All these patients underwent a successful operation for this. In 4 cases, trapezo-metacarpal osteoarthritis caused the problems. They received conservative treatment with infiltration and splinting. Ten cases presented hyper sensibility of the operated area. Six cases were treated successfully by physiotherapy. Four cases underwent reoperation. In 3 cases, the lesion, and in 1 case, the compression of the superficial branch of the radial nerve was found. Nineteen patients of the remaining 21 accepted a second operation. In all these cases, we found an unreleased tendon in an additional compartment. Conclusion: We can conclude that the failure of an operation in the De Quervain tenosynovitis is due to anatomical variations, the involvement of the radial superficial nerve, and the ignoration of another syndrome in the proximity.