Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2017-01, Vol.70 (1), p.127-131
• Main Authors: Lee, Z-Hye, MD, Stranix, J.T., MD, Anzai, Lavinia, BA, Sharma, Sheel, MD
• Format: Article
• Language: English
• Subjects: Cadaver; Case-Control Studies; De Quervain disease; De Quervain Disease - pathology; De Quervain Disease - surgery; De Quervain's tenosynovitis; First extensor compartment anatomy; Humans; Plastic Surgery; Tendinopathies
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2016.08.020

Abstract Purpose De Quervain syndrome or tenosynovitis is a common wrist pathology caused by stenosing tenosynovitis of the first dorsal compartment. Multiple studies have demonstrated significant anatomic variation within the first extensor compartment. Methods A comprehensive search of the terms “De Quervain tenosynovitis” and “first extensor compartment anatomy” was performed using the PubMed, MEDLINE and Cochrane database. The presence of a septum within the first dorsal compartment, the number of APL (abductor pollicis longus) and EPB (extensor pollicis brevis) tendon slips were identified.. Results 574 articles were identified on initial search; 21 of these met inclusion criteria. Altogether, there were 1901 normal cadaver specimens and 470 surgically treated De Quervain disease patients for which data were available. A septum was present in 43.7% in normal cadavers vs. 62.2% De Quervain patients with 58.5% (327 of 559) of the septi characterized as incomplete. There was a difference in the number of APL tendons with a single APL tendon slip noted in 18.3% of normal cadavers (200/1096) vs. 27.2% of De Quervain patients (87/230). There was a difference in the number of EPB tendons between the normal cadavers vs. De Quervain’s wrists with 2 or more EPB tendinous slips observed in 5.9% of normal cadavers compared to 2.9% of De Quervain patients. Conclusion Significant anatomic variability exists within the first extensor compartment. Patients with DeQuervain disease were more likely to have a septum dividing the compartment and to have a single slip of APL. These variations are clinically relevant in the pathophysiology and treatment of De Quervain’s tenosynovitis. Type of Study Prognostic studies. Level of Evidence Level III.