Radial ridge excision for symptomatic volar tendon subluxation following de Quervain's release.

Abstract

Traditional surgical release to address de Quervain's stenosing tenosynovitis can lead to the rare complication of volar tendon subluxation. This study presents a surgical procedure, which entails excision of the radial ridge as an alternative treatment to relieve pain associated with symptomatic volar tendon subluxation following de Quervain's release. The procedure was performed on 6 patients complaining of painful volar tendon subluxation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB), following a first dorsal compartment release and postoperative splinting. We opened the same incision sharply, with direct view of the tendons of the first dorsal compartment. The wrist was ranged through extension and flexion, and volar subluxation of the APL and EPB over the prominent radial ridge was confirmed. The bony portion of the radial ridge was excised and filed smooth. The periosteal flap is advanced over the ridge and sutured into place. The APL and EPB tendons were released from dorsal retractors. All patients reported relief upon follow-up. Excision of this ridge removes the obtrusive friction to the APL and EPB tendons, allowing them to glide painlessly over the radial styloid.