De Quervain's Disease Research Articles

Résultats cliniques et radiologiques chez les patients de moins de 65 ans porteurs de prothèses totales trapézo-métacarpiennes type Maia®

Several studies on the topic of rhizarthrosis have evaluated the clinical effectiveness of the Maia (Lepine group) prosthesis. Our study concerned younger active patients, more rarely represented and evaluated in these studies. Our aim was to evaluate the postoperative return time to professional and manual activites, correlated to clinical and radiographic results, amid an active population of Maia prosthesis bearers. We included a cohort of 28 patients of an average age of 57.8 years old (45–65), operated between 2009 and 2016 by 4 different surgeons with a follow up of 2.53 years (0,5–7). 64 % of patients were professionally active. 83 % had a regular manual activity. A total of 32 prosthesis were implanted (2 bilateral cases). We collected the postoperative return time to work and manual activities, and evaluated clinical and radiographic results through standardized scores (Moineau, Kapandji, PWRE, QuickDASH). 85 % of patients returned to a full time work-schedule within 4 months. Postoperative clinical evaluation revealed an average PWRE score of 16.4 (0–67), an average Moineau score of 16.4 and an average QuickDASH score of 27.7 out of 100 (0–86.4). No patient presented secondary de Quervain tenosynovitis. 92 % of patients were highly satisfied and all patients claimed they would recommend the operation to a relative. The functional gain does not seem trifling gathering that 85 % of patients return to their professional acitivies within 4 months, be it a manual labor or not. Functional recovery is faster than that of pure strength. Our study showed excellent clinical and radiographic results of the Maia prosthesis in professionally active patients in younger age ranges. These results can encourage the implantation of this prosthesis in active young patients. It would be interesting to study the results with a longer follow-up and a larger population.

Outcome of surgical decompression in resistant de Quervain tenosynovitis

Introductions: De Quervain tenosynovitis is a common cause of functional impairment. Steroid injection has good result but significant numbers of cases develop resistance requiring surgical decompression. This study assesses the outcome of surgery. 
 Methods: Symptomatic de Quervaint tenosynovitis cases resistant to conservative treatment that underwent surgical decompression and postoperative thumb immobilization using thumb spica splint cast during four and half years were analyzed. They were followed for at least three months for clinical and functional outcome. Patient demography, visual analogue score (VAS) and complications were analyzed descriptively. 
 Results: There were 34 cases of de Quervaint tenosynovitis, mean age 42±16 years, and female 88.2%. Treatment was successful in all cases. The mean VAS score reduced to 0.5 from 6.82, p-value <0.01. Complication occurred in one case. 
 Conclusions: Surgical decompression of de Quervain tenosynovitis was safe and effective in cases resistant to conservative treatment.

De Quervain Tenosynovitis in a 12-Year-Old Child: A Generation's Disease?

We reported a case of 12-years-old girl with isolated pain in of the left wrist. The problem had lasted for 5 weeks after a trauma, and was getting worse. Wrist X-ray was obtained, and no abnormalities were appreciated. The diagnosis after clinical and echo graphic examinations was a De Quervain's tenosynovitis which has never been reported before in pediatric orthopedic literature.

A Genetic Marker Associated with De Quervain's Tenosynovitis.

De Quervain's tenosynovitis is a repetitive strain injury involving synovial inflammation of the tendons of the first extensor compartment of the wrist. It is relatively common in the general population, and is the most common radial-sided tendinopathy seen in athletes. Identifying a genetic marker associated with de Quervain's tenosynovitis could provide a useful tool to help identify those individuals with an increased risk for injury. A genome-wide association screen was performed using publically available data from the Research Program in Genes, Environment and Health (RPGEH) including 4,129 cases and 98,374 controls. rs35360670 on chromosome 8 showed an association with de Quervain's tenosynovitis at genome-wide significance (p=1.9×10-8; OR=1.46; 95% CI=1.38-1.59). This study is the first genome-wide screen for de Quervain's tenosynovitis and provides insights regarding its genetic etiology as well as a DNA marker with the potential to inform athletes and other high-risk individuals about their relative risk for injury.

ASCOT: Autologous Bone Marrow Stem Cell Use for Osteoarthritis of the Thumb-First Carpometacarpal Joint.

Background:The first carpometacarpal joint (CMCJ) in the hand is a commonly affected joint by osteoarthritis. It causes significant thumb base pain, limiting functional capacity. Microfracturing and application of autologous stem cells has been performed on large joints such as the knee but has never been evaluated for use in the smaller joints in the hand. Our aim was to determine the potential benefit of microfracturing and autologous bone marrow stem cells for treatment of osteoarthritis of the first CMCJ in the hand.Methods:All inclusion criteria were satisfied. Preoperative assessment by the surgeon, physiotherapist, and occupational therapist was performed. The first CMCJ was microfractured and the Bone Marrow Stem Cells were applied directly. Postoperatively, the patients were followed up for 1 year.Results:Fifteen patients met inclusion criteria; however, 2 patients were excluded due to postoperative cellulitis and diagnosis of De Quervain's tenosynovitis. The mean scores of the 13-patient preoperative and 1 year follow-up assessments are visual analog score at rest of 3.23–1.69 (P = 0.0292), visual analog score on activity of 7.92–4.23 (P = 0.0019), range of motion 45.77o–55.15o (P = 0.0195), thumb opposition score 7.62–9.23 (P = 0.0154), Disability of the Arm, Shoulder and Hand score of 51.67–23.08 (P = 0.0065). Strength improved insignificantly from 4.7 kg preoperatively to 5.53 kg at 12 months (P = 0.1257). All patients had a positive Grind test preoperatively and a negative test after 12 months.Conclusions:This innovative pilot study is a new approach to osteoarthritis of the thumb.

A novel classification of the anatomical variations of the first extensor compartment.

The presence of a septum in the first extensor compartment is closely associated with the pathophysiology of de Quervain disease, and affects the efficacy of corticosteroid injection and surgical release. This study aimed to examine the incidence and length of the first extensor compartment septum.Forty sides of the wrists in 20 cadavers were used. The presence of a septum in the first extensor compartment was examined. The septum length was recorded with the radial styloid process as the reference point.The anatomical variations of the first extensor compartment were classified into 3 types. Type I compartment was found in 7 sides in males (29.2%) versus 6 sides in females (37.5%, P = .733), type II was found in 6 sides in males (25%) versus 1 side in females (6.25%, P = .21), and type III was found in 11 sides in males (45.8%) versus 9 sides in females (56.25%, P = .56). There was no significant difference in the septum length between males and females (5.3 ± 2.3 vs 4.8 ± 1.1 mm, P = .54).The incidence of a septum in the first extensor compartment is approximately 50%. The mean septum length is 5 mm. Injection at 5 mm proximal to the radial styloid process has a great chance of delivering the steroids into both subcompartments. Exposure to 5 mm proximal to the radial styloid process can avoid the overlook of subcompartment and achieve adequate decompression of the first extensor compartment.

Hand Surgery Resources Exceed American Health Literacy.

The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites. An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Index, Gunning Fog Score, Automated Readability Index, and Coleman-Liau Index. A 2-tailed z test was used to compare means. Seventy-six institutions with both plastic and orthopedic surgery training programs were identified; 42 had educational material available online. The average readability for all hand-related information was at the 11.92 grade reading level. Information regarding de Quervain tenosynovitis had the highest grade level for all plastic surgery procedures (13.45). Hand arthritis had the highest grade level for all orthopedic surgery procedures (12.82). Ganglion cysts had the lowest grade level for both plastic and orthopedic surgery (10.15 and 11.01, respectively; P = .12). Carpal tunnel release was the most commonly described procedure overall. There were no differences in text complexity among geographic regions. Online patient resources for common hand ailments are too complex for the average patient to understand. Efforts should be made to provide materials at the recommended sixth-grade reading level to improve patient education and improve the physician-patient relationship.

Shear wave elastography findings of de Quervain tenosynovitis

ObjectiveOur aim was to evaluate the feasibility of using shear wave elastography (SWE) to assess first extensor compartment tendons rigidity and its alterations with tenosynovitis. Materials and methodsWe performed B-mode ultrasound and SWE to total number of 80 participants. All participants were evaluated clinically to call the diagnosis of de Quervain tenosynovitis or to rule out the diagnosis. We composed 2 groups. Group 1 included 40 healthy volunteers (33 females and 7 male participants with ages ranging from 24 to 60 years, median age was 37.5 years) and group 2 had 40 de Quervain patients (32 females and 8 male patients with ages ranging from 25 to 51 years, median age was 34 years). SWE measurements were repeated 3 times and arithmetic average was used for the final SWE value. ResultsThe median SWE value of healthy group (group 1) was 72kPa and the de Quervain patient group (group 2) was 29kPa. Two groups demonstrated statistically significant difference (p<0.001). The ROC curve analysis was performed and the SWE value of 40.5kPA was calculated as a cut-off value for the diagnosis of de Quervain tenosynovitis with 95% specificity and 85% sensitivity. ConclusionSWE modality can provide useful data regarding de Quervain tenosynovitis.

Surgical Demographics of Carpal Tunnel Syndrome and Cubital Tunnel Syndrome Over 5 Years at a Single Institution

Carpal tunnel and cubital tunnel syndrome are the 2 most common upper-limb compressive neuropathies. However, whether the characteristics of patient populations undergoing surgery for these conditions are similar is unclear in terms of demographics and concomitant pathologies. Our null hypothesis was that there are no identifiable differences between these patient populations. A retrospective cohort study was performed by billing system query using Common Procedural Terminology (CPT) codes for all patients who underwent open carpal tunnel release (CTR) (CPT code 64721) and/or open cubital tunnel surgery (CPT code 64718) by 1 of 4 hand surgeons from August 2008 to July 2013. Application of exclusion criteria of acute trauma, revision surgery, neoplasm, age less than 18 years, and inaccurate or insufficient records resulted in identification of 1,114 patients who underwent CTR, 264 patients who underwent cubital tunnel surgery, and 76 patients who underwent both. Computerized medical records were analyzed for demographic variables, medical comorbidities, and other procedures performed under the same anesthetic. In the multivariable analysis, older age, female sex, higher body mass index, trigger finger, and de Quervain tenosynovitis were associated with CTR. Prior trauma to the anatomic site was more common in the cubital tunnel group. Diabetes mellitus was associated with patients who had both procedures. The populations of patients who undergo surgery for different upper-extremity compressive neuropathies are not homogenous: CTR is associated with older age, female sex, higher body mass index, and hand tendinopathies. Cubital tunnel decompression is associated with prior trauma to the anatomic site. Diabetic patients are more likely to have both procedures. Diabetic patients undergoing either procedure should be evaluated for other peripheral nerve compression pathologies. Diagnostic IV.

Effectiveness of therapeutic ultrasound with or without thumb spica splint in the management of De Quervain's disease.

The management of De Quervain's disease is determined more by Intuition than scientific data. The choice of first line conservative option for the management of De Quervain's disease is still a topic of debate. To evaluate the effectiveness of therapeutic ultrasound with or without spica splint in the management of De Quervain's disease (DQD). Randomized controlled trial (RCT). Outpatient department of Al-Nafees Medical College Hospital, Islamabad, Pakistan. Thirty patients who had the history of the De Quervain's disease for at least 6 months were enrolled in the study. The ages of the patient were 30-50 year. The population included housewives, maids, painters, and teachers. Thirty patients were divided into two groups. The control group was treated with therapeutic ultrasound while in the experimental group thumb spica splitting was also added. The data was collected from the subjects through Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The demographic data was presented in the form of tables. Intervention-induced changes within the groups were investigated using paired sample t-test while independent sample t-test was used to compare the two groups. Significant changes within both groups (p ≤ 0.05) were observed as a result of intervention. Additionally, significant differences in some instrument items were found between experimental and control group (p ≤ 0.05) after intervention. However, some items did not demonstrate significant changes in both groups likely because there was no effect of De Quervain's disease on those items before the intervention. The results showed that the use of therapeutic ultrasound and spica splint together is more effective than using therapeutic ultrasound alone in the conservative management of De Quervain's disease. This study provides evidence to the relevant clinicians and professionals on the utility of therapeutic ultrasound combined with thumb spica splint in the conservative management of DQD.

Clinical Sign for Missed Decompression of a Separate Extensor Pollicis Brevis Compartment in de Quervain's Disease.

Persistent pain despite previous surgery for de Quervain's disease might be due to an overlooked septum between the abductor pollicis longus tendon slips and the extensor pollicis brevis tendon, or an overlooked completely separate compartment for the extensor pollicis brevis tendon alone. In both of these instances, extension of the MP joint of the thumb against resistance elicits pain at the distal level of the first extensor compartment of the wrist. When this sign is positive, revisional surgery and decompression of the remaining septum or separate compartment is indicated.

Triggering of the abductor pollicis longus in association with deQuervain's tenosynovitis

DeQuervain's tenosynovitis is a common cause of radial-sided wrist pain. Symptoms result from a narrow first dorsal compartment and associated tendinosis of the enclosed extensor pollicis brevis and/or abductor pollicis...

Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons.

Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.

Pulley Reconstruction for Symptomatic Instability of the Tendons of the First Extensor Compartment Following de Quervain's Release.

Background Surgical management of de Quervain's tenosynovitis is based on decompression of the first extensor compartment. A simple release of the first compartment can cause instability of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons in zone seven of the extensors. The WHAT test (wrist hyperflexion and abduction of the thumb) is very effective in diagnosing this instability. Patients and Methods In this retrospective monocentric study, we analyzed a case series of 10 patients all of whom underwent a reconstruction of the first extensor compartment using a retinacular graft because of symptomatic instability after decompression surgery. The reconstruction was a modified technique of the sixth compartment. Functional outcome and characteristics of the newly reconstructed pulley were examined by physical examination with the aid of ultrasound and internationally validated questionnaires. Results Four patients had a good-to-excellent functional outcome, all of those had a maximum of two surgical procedures performed on the first extensor compartment. Six patients presented poor functional outcome. In four of them, more than two surgical procedures were performed. Minor residual instability was noted in six cases, found in both the groups. Conclusion The reconstruction procedures on the first compartment seemed to be satisfactory in treating instability of the EPB and APL tendons after primary surgical release for de Quervain's disease. Level of Evidence Level IV, observational study without controls.

Anatomic study of the first extensor compartment and the relationship between the extensor tendon width and its distal insertion

The extensor pollicis brevis (EPB) tendon normally inserts into the base of the proximal phalanx of the thumb. However, a distal insertion of the EPB tendon into the thumb interphalangeal joint has been reported in refractory cases of de Quervain's disease. We hypothesized that the EPB tendon is wider beyond the thumb metacarpophalangeal joint in patients with extended EPB. This study aimed to evaluate the relationship between the extensor tendon width and the point of distal insertion of the EPB tendon. In 45 hands from 18 male and 27 female adult cadavers, the first extensor compartment was dissected and the existence of the intertendinous septum was assessed. The extensor tendon width was measured at the midpoint of the proximal phalanx, and relationships between extended EPB tendon, existence rate of the intertendinous septum, sex, and extensor tendon width were examined. Of 45 cases, intertendinous septum and extended EPB tendon were observed in 37 (82.2%) and 23 (51.1%), respectively. There was no significant difference between the existence rates of both these factors and sex. The mean extensor tendon width in the extended EPB group was significantly greater than in the normal EPB group. The cut-off value of extensor tendon width in the extended EPB group was 7.12mm. The extensor tendon width was wider in the extended EPB group than in the normal EPB group, suggesting that the differences in the EPB tendon width can be used to identify various anatomical variations in extended EPB.

Variations of anatomy on MRI of the first extensor compartment of the wrist and association with DeQuervain tenosynovitis.

To study anatomical variations on MRI of the first extensor compartment of the wrist in DeQuervain tenosynovitis (DQT). A retrospective search for DQT patients yielded 47 subjects (51 ± 15years, 36 female, 11 male). The age-matched control group (normal first extensor compartment) was 49 ± 15years (29 female, 18 male). Two independent readers reviewed: the number of abductor pollicis longus (APL) tendon slips, tendon sheath septations (compartmentalization), and APL and EPB cross-sectional area (CSA) at the radial styloid. A tendon slip was defined as a discrete structure for ≥5 contiguous slices with its own insertion. The distribution of APL tendon slips was different for the DQT and control groups (Reader 1/Reader 2: P = 0.0001 and 0.001). The most common arrangement for both groups was two APL tendon slips. One tendon slip was less common (P = 0.03 and 0.1) and compartmentalization was more common (P = 0.003; < 0.0001) for the DQT group than the control group. There was no difference in tendon slip insertions on one or multiple bones (P = 0.1; 0.7). APL and EPB compartment CSAs were also higher for the DQT group (combined first extensor compartment area: 21.3 ± 7.6mm2; 21.0 ± 7.1) than the control group (17.2 ± 3.8; 17.1 ± 3.9) (P = 0.002; 0.002). We found a statistically significantly increased proportion of supernumerary tendon slips and compartmentalization of the first extensor compartment in patients with DQT and greater CSA of the first extensor compartment at the radial styloid, consistent with previous anatomical, surgical, and ultrasound studies.

Ultrasound-guided injection for De Quervain's disease: Accuracy and its influenceable anatomical variances in first extensor compartment of fresh cadaver wrists.

This study was designed to evaluate the accuracy of ultrasound-guided injection targeting EPB tendon sheath and influenceable anatomical variances to the accuracy in the first extensor compartment of fresh cadaver wrists. Thirty wrists of 15 cadavers were used. The wrists were divided into right-sided wrists (control group) and left-sided wrists (group A) to compare the accuracy of the manual injection technique (control group) and ultrasound-guided injection technique (group A) targeting EPB tendon sheath. To estimate the influence of anatomical variances within first extensor compartment to the accuracy of each injection techniques, control group (manual injection group) was divided into Control group I (right-sided wrists without septum) and II (right-sided wrists with septum) and group A (ultrasound-guided injection group) was also divided into group AI (left-sided wrists without septum) and group AII (left-sided wrists with septum), respectively. After the methylene blue dye injection, the location of methylene blue dye and anatomical variances in the first extensor compartment was identified by dissection. The accuracy was higher in the group A (93.3%) than in control group (40.0%, p<0.05). The accuracy in control group I (55.6%) was higher than in control group II (16.7%, p<0.05). The accuracy between group AI (100%) and group AII (85.7%) was not significantly different (p>0.05). Wrists with more EPB or APL tendon slips showed a tendency not to have septum and all intratendinous injections was occurred in the wrist with 1 EPB tendon slip or 1 or 2 APL tendon slip. Ultrasound-guided injection targeting EPB tendon ensures correct needle placement through the visualization of compartmental anatomy and improves accuracy of injection though the septum in first extensor compartment encourage inaccurate injections.

Effects of metabolic syndrome on the functional outcomes of corticosteroid injection for De Quervain tenosynovitis.

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The frequency of De Quarvain Tenosynovitis, Trigger Finger and Dupuytren Contracture accompanying Idiopathic Carpal Tunnel Syndrome

Our aim in this study was to determine the frequency of Trigger finger, De quervain tenosynovitis and Dupuytren contracture in patients who underwent Idiopathic carpal tunnel release. The frequencies of trigger finger (TF), De Quervain tenosynovitis (DQ), and Dupuytren contracture (DC) on the same or contralateral extremity were evaluated in 430 patients who underwent surgery with a diagnosis for idiopathic carpal tunnel syndrome (ICTS) from January 2008 to August 2017. The mean age of patients was 54.6 (range, 40-68), and 348 were female while 82 were male. We identified 42 cases with TF (9.76%), 7 cases with DQ (1.62%), and 10 cases with DC (2.32%). We believe that our data could provide insight for the evaluation of the Turkish population.

De Quervain disease caused by osteochondroma: A case report

De Quervain disease caused by osteochondroma: A case report