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De Quervain’s Tenosynovitis

Introduction

  • Stenosing tenosynovitis of the first dorsal compartment
  • Causes entrapment of the extensor pollicis brevis (EPB) and abductor pollicis brevis (APB) tendons at the radial styloid

Anatomy

Pathogenesis

Presentation

Treatment

Non-Surgical Options

Surgical Options

First Dorsal Compartment Release

  1. Topographical marking
    1. Identify the radial styloid
    2. Mark a chevron 1cm proximal to the styloid process
  2. Incision and dissection
    1. Incise through full thickness skin
    2. Identify and retract the radial sensory nerve(s)
      1. Can be 1 to 3 branches
  3. Annular ligament release
    1. Using a scalpel, incise through the annular ligament
      1. The ligament spans from the snuffbox to the musculotendinous junction
      2. Incise on the dorsal-most aspect of the ligament to prevent painful subluxation of the tendons
    2. Explore for an intervening septa and excise if present

References