Extensor Pollicis Brevis Tendon Research Articles

An anatomical study of extensor expansion of thumb

Introduction The presence of extensor expansion of the thumb has been reported in the literature and its mode of formation and contribution from the palmar muscles has been studied earlier. Yet, some authors deny its presence in the thumb. Objective This article evaluates the presence of the extensor expansion of thumb (EET) and its formation and contributions from palmar muscles. Methods Dissection was carried on the dorsum of the hand on 80 free upper limbs. The dorsum of thumb was carefully cleaned to look for the presence of extensor expansion. When present, its mode of formation and the contributing muscles were looked into. The mode of insertion of the extensor tendons onto the phalanges was also observed. Results In all specimens, EET had tendons of extensor pollicis longus (EPL) and extensor pollicis brevis (EPB) along its central axis. It received expansion from abductor pollicis brevis (APB; 100%) and flexor pollicis brevis (FPB; 41.2%) on the lateral side, and adductor pollicis (AP; 100%) and first palmar interosseous (PI; 50%) on the medial side. Attachment of EPL to distal phalanx (DP) was seen in 45%, and to both phalanges in 55%. EPB insertion onto proximal phalanx alone, DP alone, and both phalanges was in 46.2, 25, and 23.75%, respectively. Conclusion Extensor expansion was noted in all limbs studied. It is formed by the extensor tendons of the thumb with expansions from APB and AP on its margins. Contribution from the first PI and FPB was found to be variable. Differences in insertion of EPL and EPB to the phalanges were also noted.

Akupunktur sebagai Terapi De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a disease with pain and edema in the styloid process due to thickening of the sheathsthat encase the tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). Management of DeQuervain’s tenosynovitis include pharmacotherapy combined with conservative therapy and if it fails then surgicalintervention is required. In case of De Quervain’s tenosynovitis, acupuncture for relieving pain and stiffness. Reportedthe case of a woman aged 52 year, complaints of pain and stiffness in the left thumb since two months before went tothe Poliklinik Akupunktur dr. Cipto Mangunkusumo Nasional Hospital. On physical examination the left wrist areafound tenderness and spasm in the area of APL and EPB, VAS 4, there was limitation in the first carpometacarpal jointfunctional and Finkelstein’s test was positive. Acupuncture therapy done at the point LI5, LU7, LU9 and Ashi. Therewas pain reduction and functional improvement of the carpometacarpal joints. Acupuncture gives good results forpain and stiffness in patients with de Quervain’s.

Comparison of Analgesic Effects of UST with NSAIDs and without NSAIDs in Patients with De Quervain’s Disease

Background: De Quervain's disease has been described as an entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first dorsal compartment of the wrist is a common cause of wrist and hand pain Treatment of the disease consists of pharmacological & non-pharmacological. The non-pharmacological includes immobilization, therapeutic heat and cold, electrical nerve stimulator, thumb stabilizer splint, postural correction at work and the adjustment of tools and equipment. This randomized clinical trial was performed to find out the effects of UST with NSAIDs and without NSAIDs in the patients of De Quervain’s disease.
 Methods: This randomized clinical trial was performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over a period of six months. Group A-experimental or interventional group and group B-control group by randomization with the help of lottery. Experimental group was managed by activities of daily living (ADLs) instructions, ultrasound therapy (UST) with non-steroidal anti-inflammatory agents (NSAIDs gel), along with thumb spica splint. Control group B received previous management except non-steroidal anti-inflammatory agents (NSAIDs gel). All patients received therapeutic ultrasound in a same dosage (1 watt/ cm 2/min) for 8 minutes. An evaluation was made at initial visit and two weeks interval for 6 weeks. So, there were three follow up visits and these evaluations were performed by the same investigator. In each visit, measurement of pain intensity and disability level were performed by using visual analogue scale (VAS), Tenderness Index and Patient rated wrist evaluation (PRWE) respectively. All results was recorded systematically. A post intervention result was compared with baseline result by SPSS-20
 Results: Out of 60 total patients 60(100%) had Finkelstein test positive. Significant difference between Group A and Group B was found at week 4 and Week 6 follow up (P<0.05) whereas other early follow up was non-significant in VAS analysis (p>0.05). Significant difference between Group A and Group B was found at week 4 and week 6 follow up (P<0.05) regarding change of tenderness and PRWE.
 Conclusion: Regarding treatment of De Quervain's disease, present study shown that UST with NSAIDs gel reduces the morbidity and relief of pain of patients when in comparison to other conventional treatment.
 TAJ 2019; 32(1): 25-32

Extensor pollicis longus rerouting for thumb-in-palm deformity in cerebral palsy: a biomechanical analysis.

Extensor pollicis longus rerouting is a common procedure to improve thumb abduction in thumb-in-palm deformity seen with spastic cerebral palsy. In 1985, Manske redirected the extensor pollicis longus tendon in this procedure through the first extensor compartment. They also proposed an alternative subcutaneous route around the extensor pollicis brevis and abductor pollicis longus tendons proximal to the extensor compartment. In this study, we performed a three-dimensional analysis of thumb motion on 11 cadaver arms with the subcutaneous route and the first extensor compartment route. We found that with the two different routing methods, the mean difference in thumb radial abduction and retropulsion (0° or 6°, respectively) was very small. Such differences are unlikely to have clinical relevance. We were unable to find significant differences in the motion range of the thumb after these rerouting techniques or sites of insertion. Our biomechanical data support the simpler subcutaneous route.

A Prospective Evaluation of the Anatomy of the First Dorsal Compartment in Patients Requiring Surgery for De Quervain's Tenosynovitis.

Background We prospectively evaluated the surgical anatomy during first dorsal compartment release for De Quervain's tenosynovitis, with special attention to the superficial branch of the radial nerve (SBRN). Additionally, the incidence of tendon instability during surgery was assessed. Methods This prospective cohort study consisted of 130 De Quervain's patients undergoing first dorsal compartment release. The treating surgeons recorded the type of incision used, the number of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slips, the number of SBRN branches encountered, additional subcompartments created by any septations, and active/passive tendon stability. Results A singular first dorsal compartment was found in 37% of cases, whereas 55% of patients had two subcompartments and 8% had three. Multiple APL tendon slips (range: 1-4) were identified in 78% of patients. In contrast, a single EPB tendon was found in 92% of patients (range: 0-2). At least one SBRN was encountered in 61% of cases. Following surgery, instability was evident in 9% of patients, who had tendons perch with passive wrist flexion. In one of these patients (<1%), the tendons dislocated volarly out of the first dorsal compartment during active flexion. Conclusions The anatomical findings in our relatively large, prospective study of De Quervain's patients undergoing first dorsal compartment release are consistent with previous smaller and/or retrospective studies. Overall, we expect to encounter the SBRN during first dorsal compartment release in more than 50% of patients but are unconcerned if it is not visualized during a careful approach. Tendon instability has an incidence of 9%; however, dislocation is rare (<1%).

Repair of the pronator quadratus muscle with apart of the brachioradialis muscle insertion in volar plate fixation of adistal radius fracture

Stable pronator quadratus repair following volar plate fixation of distal radius fractures with complete plate coverage is often difficult. Detachment of the pronator quadratus muscle (PQ) with astrong rim of connective tissue consisting of afibrous portion of the roof of the first extensor compartment and the volar limb of the brachioradialis muscle (BR) insertion; stable suture repair of the PQ with complete coverage of avolar plate after osteosynthesis of adistal radius fracture. Radiopalmar approach between the radial artery and the flexor carpi radialis tendon to the PQ; sharp dissection below the radial artery onto the first extensor compartment, which is opened; retraction of the extensor pollicis brevis and abductor pollicis longus tendon; presentation of the BR insertion at the bottom of the first extensor compartment; incision of the BR insertion halfway to proximal and dissection of the volar limb at the transition to the free BR tendon; release of the PQ from the distal radius; after reduction and internal fixation repair of the PQ with complete coverage of the volar locking plate due to slight distal transposition. Pronator quadratus repair with apart of the brachioradialis muscle insertion is areliable technique for coverage of avolar plate by slight distal transposition. In the repair of distal radius fractures, this may protect the finger flexor tendons against irritation and/or rupture.

Intra sheath corticosteroid injection for De Quervain’s tenosynovitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; De Quervain’s disease or stenosing tenosynovitis of the first dorsal compartment of the wrist is a common condition, which affects the Abductor pollicis longus and the extensor pollicis brevis tendons. There are characteristic signs and symptoms including a positive Finkelstein's test. Different options for treatment include conservative approaches like analgesics, splinting and physical therapy. If conservative options fail then steroid injection is considered.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective study of single dose intra-sheath triamcinolone and lignocaine injection in 32 patients at our institute who were followed up for a period of 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study there were 25 females and 7 males with a mean age of 46.4±8.03 years. Right side was involved in 17 patients and left side in 15 patients. The pre procedure VAS score was 8.65±1.07. The follow up VAS scores at 1, 6 and 12 months respectively were 1.4±1.14, 0.84±1.06 and 1.03±1.26 respectively. 4 out of 32 patients had positive Finkelstein’s test at 1 year follow up. Common complications were pain at injection site, which was seen in 5/32 patients and depigmentation seen in 2/32 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus intra sheath triamcinolone injection is a safe and effective procedure for treatment of De Quervains disease.&lt;/p&gt;

Dorsal plate arthrodesis of the thumb metacarpophalangeal joint

Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. Local infection of the thumb metacarpophalangeal joint area. Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20°flexion and K‑wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. Splint for 3weeks. Full load after 6-8weeks. The dorsal plate arthrodesis of the thumb MP joint is areliable surgical method with very good functional results.

Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study.

Background: The reported prevalence of a subcompartment housing the extensor pollicis brevis (EPB) tendon within the first dorsal compartment varies widely in the literature, especially regarding the rates of occurrence between genders and among those with and without De Quervain. Based on direct intraoperative observation, we hypothesized that the prevalence of a septated compartment is far greater than previously reported, particularly in those with De Quervain disease. Methods: A prospective analysis of consecutive patients who underwent first dorsal compartment release was carried out. Patients were divided into 2 groups: those with De Quervain tenosynovitis ("De Quervain" group) and a control cohort without a primary diagnosis of De Quervain ("non-De Quervain" group). The intraoperative findings of a single compartment or a separate subcompartment were recorded. The prevalence of a septated compartment was calculated and compared between genders and both patient groups. Results: A total of 102 consecutive patients were included, with a female predominance (74.5%). Overall, 79.4% of patients had a separate subcompartment for the EPB. In the De Quervain cohort, 89.1% had 2 compartments, while 71.4% of non-De Quervain patients had a subcompartment. Men and women had a similar rate of double compartments (80% and 82.4%, respectively). Conclusions: The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients afflicted with De Quervain tenosynovitis. This higher rate of septation occurs with a similar prevalence in both men and women. Owing to its consistent presence, the dual first dorsal compartment should be regarded as an expectant anatomical component of the normal wrist.

Clinical Examination of the Extensor Pollicis Brevis: Anatomical Study and Description of a Novel Clinical Sign.

The Extensor Pollicis Brevis (EPB) is an extrinsic thumb muscle whose main function is extension of the first metacarpophalangeal joint (MCPJ). It is subject to significant anatomical variation and may be absent, vestigial or have an anomalous distal attachment. Clinical examination of EPB is notoriously difficult and no reliable test has yet been described. We propose a novel test for the accurate examination of EPB. We sought to clarify the anatomical variations of EPB and to validate our clinical test using human cadaveric anatomical tests. A structured literature review of all human cadaveric anatomical studies describing the attachments of EPB was performed using MEDLINE and Embase with the key words "Extensor Pollicis Brevis". A cadaveric anatomical study was performed using 18 unembalmed upper limbs. Positive and negative tests were simulated by manipulating the tendons of EPB, Extensor Pollicis Longus (EPL) and Flexor Pollicis Longus (FPL). Changes in tendon tension and joint position were measured and recorded. The EPB anatomy was then determined by dissection. Anatomical variations were present in the majority of wrists, with only 35% of EPB tendons having a distal attachment to the proximal phalanx alone. EPB was absent in 5% of specimens. There was a significant difference between the change in MCPJ position between a positive (36 degrees; 95% CI 25 to 47 degrees) and negative (19 degrees; 95% CI 14 to 25 degrees) clinical test (p = 0.002). The functional importance of EPB depends on its congenital architecture in addition to the functional demands of the patient. We report a novel clinical test which is effective in demonstrating the integrity of the EPB. A positive test result is observed when a change in MCPJ position that occurs while the interphalangeal joint is brought into flexion from full thumb extension is 25 degrees or more.

Anatomical variations in the first extensor compartment: a cadaver study.

Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.

Anatomical study of the first dorsal extensor compartment for the treatment of de Quervain’s disease

IntroductionAnatomical variations of the first dorsal extensor compartment (1st EC) are commonly noted. Materials and methodsForty cadaver hands were dissected to define the 1st EC. Through the gross findings, we classified the contents according to the presence of septation, subcompartment, and variation of tendons. Bony cross-section of the wrist was performed to reveal any bony pattern within the 1st EC. We also measured the anatomical structures of the 1st EC. ResultsA septum that results in subcompartments was present in 24, complete in 2 and incomplete in 22 hands distally. The mean size of the 1st EC was 20.69±12mm in length, and 8.65±0.67mm in width. The mean length of the septum was 11.18±5.18mm, while the mean width of the subcompartment was 3.18±0.40mm. All the subcompartments enclosed only extensor pollicis brevis (EPB) tendons. The mean number of abductor pollicis longus and EPB tendon slips was 2.6±0.5 and 1.1±0.2, respectively. The bony floor of the 1st EC was classified into five types. Two distinctive grooves separating two tendons with protruding osseous ridge (type I, n=9), two distinctive grooves separating two tendons without protruding osseous ridge (type II, n=10), a single distinct groove with osteophytes (type III, n=16), indistinct groove with fibrous septum separating two tendons (type IV, n=4), and indistinct groove without fibrous septum (type V, n=1). ConclusionKnowledge about the 1st EC abnormality is mandatory for the successful treatment of de Quervain’s disease.

Variations of extensor pollicis brevis tendon in Indian population: A cadaveric study and review of literature

ObjectivesVariations of the tendons of the first dorsal compartment of the wrist may be one of reasons of treatment failure and recurrence in De Quervain's tenosynovitis (DQT). The present cadaveric study was designed to look into the variations of the Extensor pollicis brevis (EPB) tendon in Indian population. MethodsSeventy-seven formaldehyde-fixed cadaveric upper limbs of Indian origins were dissected to observe the number of EPB tendons and its variations. ResultsThe EPB muscle was found to be absent in one hand (1.3%). The EPB muscle was found with single tendon, two tendons and three tendons in 73 limbs (94.8%), 2 limbs (2.6%) and one limb (1.3%) respectively. The muscle originated from the posterior surface of the radius and the adjacent interosseous membrane. The EPB muscle with single tendon was found to be inserted into the distal part of dorsal surface of the proximal phalanx of the thumb in 44 limbs (57.1%). In limbs with bitendinous EPB, the tendon slips were inserted into the base of proximal phalanx and into the base of distal phalanx of the thumb. An Osseo-fibrous septum separating EPB from Abductor Pollicis Longus (APL) was observed in 45 limbs (58%). ConclusionEPB in first extensor compartment of Indians is usually monotendinous. It mostly inserts into the distal part of dorsal surface of proximal phalanx of thumb and into the base of distal phalanx. In majority of the wrists, one may find an osseofibrous ridge separating EPB from APL. These anatomical variations may be helpful to guide proper treatment in de Quervain’s tenosynovitis.

Accuracy of Injection Into the First Dorsal Compartment:A Cadaveric Ultrasound Study.

To determine the accuracy of ultrasound-guided (UG) injections compared with anatomic landmark-guided (AL) injections in the first dorsal compartment (FDC) with the hypothesis that ultrasound guidance would increase the accuracy of injection. We randomized 43 above-elbow cadaveric specimens to receive latex dye injections into the FDC via a UG or AL technique. If ultrasound imaging identified a septated FDC, the needle was redirected and a portion of the dye was injected around the extensor pollicis brevis (EPB) tendon. Specimens were dissected and data collected regarding the location of the dye and presence of a septated FDC. Fisher exact test was used to calculate the difference in accuracy rates of injections. All 21 specimens injected via UG and all 22 specimens injected via the AL technique demonstrated dye within the FDC. Eight of 21 specimens in the UG group and 6 of 22 specimens in the AL group demonstrated a septated FDC upon dissection. Ultrasound was able to identify 6 of 8 specimens accurately with a septated FDC, representing a sensitivity of 75% and specificity of 92%. Six of 8 specimens with a septated FDC in the UG group versus 2 of 6 specimens with a septated FDC in the AL group demonstrated dye infiltration around the EPB. Dye was noted in the subcutaneous tissues in 2 of 21 specimens in the UG group versus 2 of 22 specimens in the AL group. The UG- and AL-based injections both had excellent dye infiltration into a portion of the FDC. Ultrasound-guided injections had a higher observed infiltration rate in EPB subcompartments than the AL technique, but could not be statistically confirmed to be different. Ultrasound is unlikely to increase the accuracy of injections into an unseptated FDC. It may aid in injection of a septated FDC; however, that remains to be statistically demonstrated.

Analysing orthotic designs for de Quervain's disease based on in vivo gliding distance of extensor pollicis brevis tendon

Background/Aims: To reconsider orthotic designs used for de Quervain's disease based on in vivo information obtained from ultrasound images. Methods: The hands (n=40) of 20 healthy adult men and women participants with no history of thumb injury or deformation were examined. A two-dimensional tissue tracking system was used to quantitatively measure in vivo gliding distance in the extensor pollicis brevis tendon during thumb interphalangeal joint autonomic movement while wearing a thumb spica orthosis. Findings: Results revealed anatomical variations in the insertion of the extensor pollicis brevis tendon in 9 (22.5%) hands. A septum was noted in the first dorsal compartment of the extensor tendon in 23 (57.5%) hands. Multiple comparison testing of gliding distance across four groups, classified by the presence or absence of anatomical variations and/or septa using Tukey's test, revealed significant differences for gliding distance between groups with and without anatomical variations, regardless of whether septa were observed (p=0.01). Conclusions: It is necessary to evaluate physical characteristics such as septa and anatomical variations based on advanced screening with ultrasound examinations before considering thumb fixation range for patients in the acute inflammation phase or those exhibiting recurrence of de Quervain's disease.

Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people

Study DesignCross-sectional, observational study. IntroductionThere is little reported on the in vivo mechanics and behavior of extensor pollicis brevis (EPB) in relation to wrist position. Wrist position is known to significantly influence tendon excursion and therefore function of the digits. Ultrasound imaging (USI) can be used to assess in vivo tendon behavior and excursion. An improved knowledge of the excursion of the EPB tendon is important in understanding normal tendon mechanics and potentially pathological tendon disorders such as de Quervains tenosynovitis. Purpose of the StudyTo assess the reliability of using USI to measure EPB tendon excursion and to quantify EPB tendon excursion in 3 wrist positions. MethodsUSI with speckle-tracking analysis were utilized to assess 49 normal EPB tendons (25 subjects). Tendon excursion was measured in wrist flexion (45°), wrist neutral and wrist extension (45°) on 2 different occasions. ResultsThe within- and between-session reliability of using USI to quantify EPB tendon excursion was “excellent” and “high,” respectively. Wrist position had a significant influence on EPB tendon excursion (P ≤ .05). EPB excursion in the neutral wrist position was statistically greater than the other 2 positions (P < .05). DiscussionEPB tendon excursion has been shown to be dependent on the wrist positions of flexion and extension. The measures are notably lower than those found in cadaver studies; however, they follow a similar pattern with greatest excursion occurring in the neutral wrist position and least in flexion. This information is useful for EPB tendon rehabilitation and in consideration of biomechanics and pathogenesis of disorders that affect EPB tendon. ConclusionIn vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. USI with speckle-tracking analysis are considered to be reliable methods for measuring EPB tendon excursion.

Variant course of extensor pollicis brevis tendon in the third extensor compartment.

According to the anatomical literature, the extensor pollicis brevis (EPB) tendon passes through the first compartment and enters the base of the proximal phalanx of the thumb. There have been a few reports on the different types of supernumerary EPB tendons; however, an unusual course of the EPB tendon is extremely rare. During routine cadaveric dissection in the Department of Gross Anatomy, we detected an variant EPB muscle in a 96-year-old fresh female cadaver. The EPB muscle originated from the posterior surface of the radius and interosseous membrane. However, the EPB tendon passed through the third compartment instead of the first compartment. It ran parallel to the extensor pollicis longus (EPL) tendon and entered the base of the thumb proximal phalanx. The EPL tendon was attached to the base of the first distal phalanx, as normally observed. Both EPB and EPL muscles were innervated by the posterior interosseous nerve. We report a case of a variant course of the EPB tendon appearing in the third extensor compartment of the wrist with the EPL tendon. The knowledge of this anatomic variation will be helpful for accurate diagnosis and surgical planning.

To study the role of ultrasonography in diagnosis, management and prevention of incomplete surgical release in patient’s of de Quervain’s disease

Background: Fritz de Quervain, in 1895, described the tenosynovitis of first extensor compartment tendons of abductor pollicis longus and extensor pollicis brevis. Clinically characterized by pain and swelling over the radial styloid process, a positive finkelstein test and accompanied by a palpable thickening of the tendon sheaths and painful wrist and thumb movements. The diagnosis is usually clinical and the treatment varies from conservative to surgical decompression of the first extensor compartment. Materials and Methods: This is a prospective study of 28 patients of de Quervain’s tenosynovitis involving 30 wrists treated in Father Muller Medical College and Hospital, Mangalore between 1 September 2015 and 30 November 2016. Results: A total of 28 patients and 30 wrists were examined in this study. The disease was found to be more common in fourth and fifth decade of life. In our study there were 23 females out of total 28 patients. Right wrist was more commonly affected than the left. Out of 28 patients 18 underwent surgery. Total 20 wrists out of 30 were surgically decompressed. Ultra sound showed the presence of single tendon of APL in 16 wrists (53.3%) and more than 1 tendon in 14 cases (46.7%). Out of 20 wrists which were operated 12 had 2 slips of APL and 8 had one slip of APL. Ultrasonography correctly identified the number of tendons in all except one case, in which it under diagnosed the number of tendons. Conclusion: Though ultrasound could not pick up a sub compartment it can still prevent the complication of incomplete surgical release as it correctly identifies the number of tendons. We strongly recommend looking for a sub compartment when the number of tendons seen on ultrasound is more than that found intraoperatively.

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.

Role of preoperative ultrasonography in De Quervain’s disease

Background: Fritz De Quervain first described the tenosynovitis of first extensor compartment tendons of abductor pollicis longus and extensor pollicis brevis and hence the affection bears his name. Clinically characterized by pain and swelling over the Radial styloid process, a positive finkelstein test and accompanied by a palpable thickening of the tendon sheaths and painful wrist and thumb movements. The diagnosis is usually clinical and the treatment varies from conservative to surgical decompression of the first extensor compartment. Materials and Methods: This is a prospective study of 28 patients of de Quervain’s tenosynovitis involving 30 wrists treated in Father Muller Medical College and Hospital, Mangalore between 1 July 2015 and 30 September 2016 Results: Total 28 patients and 30 wrists were examined in this study. The disease was found to be more common in fourth and fifth decade of life. In our study there were 23 females out of total 28 patients. Right wrist was more commonly affected than the left. Out of 28 patients 18 underwent surgery. Total 20 wrists out of 30 were surgically decompressed. Ultra sound showed the presence of single tendon of APL in 16 wrists (53.3%) and more than 1 tendon in 14 cases (46.7%).Out of 20 wrists which were operated 12 had 2 slips of APL and 8 had one slip of APL. Ultra sound correctly identified the number of tendons in all except one case, in which it under diagonosed the number of tendons. Conclusion: Though ultrasound could not pick up a sub compartment it can still prevent the complication of incomplete surgical release as it correctly identifies the number of tendons. We strongly recommend looking for a sub compartment when the number of tendons seen on ultrasound is more than that found on table.