De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2011-09, Vol.97 (5), p.489-493
• Main Authors: Altay, M.A, Erturk, C, Isikan, U.E
• Format: Article
• Language: English
• Subjects: Adult; Aged; De Quervain Disease - surgery; De Quervain's disease; De Quervain's tenosynovitis; Extensor retinaculum; Female; Humans; Male; Middle Aged; Orthopedic Procedures - methods; Orthopedics; Partial resection; Prospective Studies; Surgery; Surgical treatment; Tendons - surgery; Young Adult
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2011.03.015

Summary Background Several operative methods have been described for de Quervain's disease, but no definite consensus has emerged in the literature. Sometimes simple release of the extensor retinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of the extensor retinaculum can cause volar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons. In this prospective study, we evaluated the early results of operative treatment with one-quarter partial resection of the extensor retinaculum when conservative methods have failed. Hypothesis We hypothesized that partial removal of the extensor retinaculum may be used as an alternative to solve problems such as incomplete release or re-adhesion and volar subluxation of the tendons. Patients and methods Thirty-four patients (36 hands; 30 females and four males; mean age: 48.2 years; range: 20 to 75 years) with de Quervain's disease were surgically treated. The surgical procedure was performed under local infiltration anesthesia. One-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist was performed. During the clinical follow-up period, treatment results, a patient-based scoring system and visual analogue scale were used. The mean follow-up duration was 23.7 months (range: 12 to 71 months). Results Two patients with wound infections were treated with adapted antibiotics. All patients were relieved of their symptoms; no triggering, recurrence or volar subluxation of the tendons of abductor pollicis longus or extensor pollicis brevis occurred. With this partial resection technique and according to a treatment scoring system described by Sawaizumi et al., 23 hands had excellent results, 11 hands had good results, and two hands had fair results; no hand exhibited a poor result. The mean visual analogue scale score was 1.8 (range: 0–6). Discussion Our results showed that one-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist can be safely used for the operative treatment of de Quervain's disease with satisfactory short-term clinical results and no serious complications. Level of evidence Level IV: low-power prospective study.