Tenosynovitis ni De Quervain Impormasyon

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang sakit sa labas ng iyong pulso, malapit sa base ng iyong hinlalaki. Ang lugar na ito ay tinatawag na radial styloid. Ang sakit ay nagmumula sa pamamaga sa mga tendon na gumagalaw sa iyong hinlalaki. Maaaring mapansin mo ang pamamaga o pakiramdam ng higpit sa lugar na ito.

Karaniwang lumalala ang sakit kapag gumagalaw ang iyong hinlalaki o pulso. Maaaring maging mahirap ang mga simpleng gawain sa araw-araw. Maaaring mahirapan kang hawakan ang mga bagay, itaas ang tasa ng kape, o ikutin ang susi. Maaaring masakit ang pag-abot sa likod upang isara ang brassiere. Maaari ring magdulot ng discomfort ang pagtupi ng iyong kamiseta. Kung matutulog ka sa apektadong gilid, maaaring pigilan ka ng sakit na matulog o guminaw ka.

May mga taong nararamdaman ang sakit kapag gising sila sa umaga. May mga taong napapansin itong lumalala matapos gamitin ang kanilang kamay nang ilang panahon. Kung mayroon kang nakaraang sugat sa iyong pulso, maaaring may kaugnayan ang kondisyong ito sa nasabing trauma. Mas karaniwan ito rin sa panahon ng pagbubuntis.

Kung ang sakit ay nasa ibang lokasyon kaysa sa base ng iyong hinlalaki, maaaring dulot ito ng iba pang bagay. Sa bihirang kaso, maaaring mahuli o makabit ang mga tendon. Ito ay kilala bilang triggering. Kung mangyari ito, madalas na kinakailangan ang operasyon upay ayusin ito. Gayunpaman, karamihan sa mga tao ay nagsisimula muna sa mga non-surgical na paggamot.

Sisiyasatin ng iyong surgeon ang mga partikular na sintomas na ito upang kumpirmahin ang diagnosis. Maaaring hilingin sa iyo na gumalaw ng iyong hinlalaki sa mga tiyak na paraan upang makita kung nagdudulot ito ng sakit. Ang pagtugon sa iyong mga alalahanin tungkol sa tagal ng kondisyong ito ay makakatulong upang magdesisyon ka sa pinakamainam na paggamot para sa iyo.

Ano ang nangyayari talaga

Ang tenosynovitis ni De Quervain ay isang kondisyon na dulot ng pagkasira dahil sa paggamit na nakakaapekto sa mga tendon sa gilid ng pulso na may kinalaman sa hinlalaki. Ang mga tendon ay matigas, tulad ng lubid na mga hibla na nag-uugnay sa iyong mga kalamnan sa iyong mga buto. Pinapayagan nito kang gumalaw nang maayos ang iyong hinlalaki at pulso.

Dumadaan ang mga tendon na ito sa isang makitid na tunnel na tinatawag na sheath. Isipin ang sheath na ito bilang isang protektibong sleeve o gasket na nagpapanatili ng tendon sa tamang posisyon. Sa de Quervain’s, ang sleeve na ito ay namamaga at nanunubok. Ang pamamaga ay nagpapagitan ng espasyo sa loob ng tunnel na mas makitid kaysa sa dapat.

Kapag sinusubukan mong gumalaw ang iyong hinlalaki o pulso, ang namamagang tendon ay nakikipagkuskos sa makitid na pader ng sheath. Ang kuskos na ito ay nagdudulot ng sakit, pamamaga, at pakiramdam ng pagkakadikit. Maaaring maranasan mo ang pakiramdam ng pagkagiling o pagpuputok kapag gumagalaw ang iyong kamay. Ito ay dahil ang tendon ay nahihirapang dumulas sa makitid na tunnel.

Karaniwang matatagpuan ang sakit sa radial styloid, na ang buto na tumutubo sa gilid ng pulso na may kinalaman sa hinlalaki. Kapag pinindot ang lugar na ito, madalas itong maramdaman na masakit. Maaari mo ring mapansin ang katigasan sa mga joint ng iyong hinlalaki, bagaman bihira ito.

Minsan, maaaring parang galing sa ibang lugar ang sakit. Kung hindi sa radial styloid ang iyong sakit, maaaring hanapin ng iyong surgeon ang ibang mga sanhi. Ang mga kondisyon tulad ng karagdagang muscle belly o pamamaga sa mga malapit na compartment ng tendon ay maaaring magmukhang katulad ng de Quervain’s. Gumagamit kami ng imaging, tulad ng ultrasound o MRI, upang malinaw na makita ang mga malambot na tissue. Ang ultrasound ay partikular na mahusay sa pagpapakita ng anatomiya ng unang extensor compartment kung saan nakatira ang mga tendon na ito.

Ang pag-unawa sa nangyayari ay tumutulong sa iyo na gumawa ng mga desisyong may kaalaman. Maaari kang pumili ng mga nonoperative na gamot muna, tulad ng pahinga o corticosteroid injections. Ang mga injection na ito ay maaaring bawasan ang pamamaga at baguhin ang daloy ng kondisyon. Kung patuloy ang mga sintomas, maaaring isaalang-alang ang surgical release upang palawakin ang tunnel at bawasan ang presyon sa tendon.

Mga maitutulong namin dito

Paano kinikilala ni Dr. Kieran Hirpara, isang iskultura sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, ang sitwasyong ito sa aming klinika ay nagpapakita ng malinaw na landas: ang mga pasyente ay dumadating sa amin sa pamamagitan ng referral mula sa GP o physiotherapist. Ang pagsusuri sa klinika (kasaysayan, pagsusuri, at pag-imaging kung kinakailangan) ang nagtatag ng diagnosis. Para sa mga dehenratibo o matagal nang problema, karaniwan naming sinusubukan ang hindi operatibong paggamot — pagbabago ng aktibidad, physiotherapy o hand therapy, paggamit ng splint, at mga injeksyon — at isinasalang-alang ang operasyon kapag hindi ito nagbigay ng sapat na pagpapabuti. Para sa mga structural o akutong problema, maaaring irekomenda agad ang operasyon, nang walang nakaraang pagsubok sa hindi operatibong paggamot.

Maaari kang magsimula sa pagbabago ng paraan ng paggamit ng iyong kamay. Iwasan ang mga galaw na nagpipipit o nagtutwist ng iyong hinlalaki, tulad ng pag-angat ng mabigat na kawali sa hawakan. Maaaring gabayan ka ng iyong physiotherapist sa mga banayad na paghuhubog upang panatilihin ang maayos na paggalaw ng mga tendon. Inirerekomenda rin namin ang paggamit ng thumb splint upang pahintulutan ang rehiyong ito na magpahinga. Ang simpleng suporta na ito ay tumutulong upang bawasan ang tensyon habang humihina ang pamamaga. Bigyan ang mga hakbang na ito ng ilang linggo upang magtrabaho. Kung patuloy ang iyong sakit, lumilipat kami sa susunod na hakbang.

Ang medikal na pamamahala ay nakatuon sa pagbawas ng pamamaga at sakit. Ang pinakamainam na unang paggamot ay isang corticosteroid injection sa tendon sheath. Ito ang tanging hindi operatibong opsyon na maaaring potensyal na baguhin ang daloy ng kondisyon. Ito ay gumagana sa pamamagitan ng pagpapakalma ng pamamaga nang direkta sa pinagmulan. Para sa maraming pasyente, ang isang o dalawang injeksyon ay nagbibigay ng malaking ginhawa. Ang ebidensya ay nagpapakita na ang mga corticosteroid injection ay nagdudulot ng tagumpay sa paggamot 73.4% ng kaso sa loob ng 2 injeksyon. Sa ilang kaso, ang isang injeksyon ay epektibo sa pagpapagaan ng mga sintomas sa 82% ng mga pasyente, na may higit sa kalahati na nanatiling walang sintomas sa loob ng hindi bababa sa 12 buwan. Pinagsasama namin ito sa maikling panahon ng immobilization upang tulungan ang tendon na gumaling. Kung mayroon kang diabetes, pakitandaan na mayroon kang babaang probabilidad ng tagumpay pagkatapos ng isang injeksyon kumpara sa mga hindi diabetic na pasyente. Gayunpaman, ang epektibidad ng bawat karagdagang injeksyon ay tila hindi bumababa sa mga pasyenteng may diabetes.

Ang operasyon ay isinasalang-alang kapag ang konserbatibong paggamot ay umabot na sa hangganan nito. Ito ay bihira, dahil ang karamihan sa mga kaso ay umuunlad nang walang ito. Ang surgical release ay karaniwang inialok para sa triggering, isang bihirang kondisyon kung saan ang tendon ay nakakabit, o kapag ang mga injeksyon ay nabigo na magbigay ng pangmatagalang ginhawa. Ang proseso ay kinabibilangan ng pagpapalaya ng mahigpit na sheath sa paligid ng tendon upang pahintulutan itong mag-glide nang malaya. Ipinag-uusapan namin ang opsyong ito sa iyo lamang pagkatapos na maubos ang mga hindi operatibong paraan o kung ang iyong tiyak na anatomia ay nangangailangan nito.

Ano ang inaasahan

Ang tenosynovitis ni De Quervain ay isang kondisyon kung saan namamaga ang mga tendon sa gilid ng iyong pulso. Karamihan sa mga tao ay nakakakita na ang pagmagsimula sa non-surgical na paggamot ang pinakamainam na unang hakbang. Ang pinakainirerekomendang paunang gamutan ay isang corticosteroid injection sa apektadong lugar. Ito ang tanging non-surgical na opsyon na makapagpapabago sa daloy ng kondisyon.

Kapag natatanggap mo ang injection na ito, madalas itong pinagsasama sa maikling panahon ng pahinga para sa iyong pulso. Epektibo ang paraang ito para sa maraming pasyente. Sa katunayan, matagumpay ang paggamot sa 73.4% ng mga kaso sa loob ng dalawang injection. Kung mayroon kang diabetes, maaaring mas mababa ang iyong tsansang magtagumpay sa isang injection kumpara sa mga walang diabetes. Gayunpaman, nananatiling epektibo ang karagdagang mga injection para sa iyo rin.

Kung hindi magbigay ng pangmatagalang ginhawa ang mga injection, maaaring isaalang-alang ang operasyon. Mahalagang malaman na hindi lahat ng mga tao ay nangangailangan ng operasyon. 34.9% lamang ng mga pasyente na may bagong sintomas ang nangangailangan ng operasyon sa loob ng isang dalawang-taong panahon ng pagsubaybay. Karamihan sa mga pasyente na lumipat sa operasyon ay ginawa ito sa loob ng isang taon mula sa kanilang unang bisita. Mas malaki ang tsansa na kailanganin mo ng operasyon kung ang iyong sakit ay malaki ang epekto sa iyong pang-araw-araw na buhay o kung mababa ang iyong mga marka ng pisikal na kakayahan.

Para sa mga sumailalim sa operasyon, ang pangkalahatang tanawin ay positibo. Ang endoscopic release, isang minimally invasive na teknika, madalas na nagbibigay ng mas maagang pagpapabuti kumpara sa tradisyonal na bukas na operasyon. Mas marami rin itong nagdudulot ng mas kaunting komplikasyon sa mga nerbiyos at mas magandang kasiyahan sa peklat. Habang maaaring bumaba ang rate ng tagumpay sa paggamot sa pamamagitan ng maramihang injection, nananatiling viable na opsyon ang mga ulit na injection na may mataas na rate ng tagumpay.

Maaaring manatili ang iyong mga sintomas kung hindi ito gagamutin, ngunit maaari rin itong makapagpahinga sa tamang paggamot. Ang pagtugon sa anumang maling akala tungkol sa tagal nito ay tumutulong sa iyo na gumawa ng mga desisyon na may kaalaman. Ang iyong surgeon ay tutulong sa iyo na pumili ng landas na pinakanaaangkop sa iyong mga halaga at istilo ng buhay.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa gilid ng pulgar ng iyong pulso na hindi gumagaling kahit pahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang kahinaan, kawalan ng katatagan, o kung ang iyong pulgar ay nakakabit o biglang bumabagsak. Ang mga sintomas na nakakaapekto sa pagtulog o trabaho ay dapat din suriin. Kung ang mga diagnostic test ay nagdudulot ng sakit sa ibang lokasyon maliban sa radial styloid, maaaring kailanganin ang advanced imaging upang hanapin ang ibang sanhi. Bagama't nakakatulong ang corticosteroid injections sa 73.4% ng mga pasyente sa loob ng dalawang paggamot, ang maagang pagsusuri ay tinitiyak na makakakuha ka ng angkop na paggamot. Tinutugunan namin ang mga maling akala upang matulungan kang gumawa ng mga desisyon na may kaalaman tungkol sa iyong paggaling.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Epidemiology and Patient Perspective

Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [6].
Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [19].

Non-Operative Management

Corticosteroid injection is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment [2].
Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [14].
Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option [20].
Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values [3].

Surgical Anatomy

Variations in the surgical anatomy of the first extensor compartment are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis [1].

Operative Management

Surgical release of De Quervain's tenosynovitis remains the gold standard treatment [4].
Longitudinal incision offers the advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions, and less risk of palmar subluxation of tendons [4].
The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity [12].
Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments, despite a little increase in operation time [23].
Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release [25].
Pulley reconstruction gives satisfactory medium-term results and should be considered part of the surgical treatment for de Quervain tenosynovitis [7].

Anatomy & Pathophysiology

Variations in the surgical anatomy of the first extensor compartment are clinically relevant to the pathophysiology and treatment of De Quervain's tenosynovitis [1].
The superficial branch of the radial nerve is encountered in more than 50% of patients requiring surgery for De Quervain's tenosynovitis [45].
Diagnostic maneuvers for De Quervain tenosynovitis that produce pain in a location other than the radial styloid may indicate other anatomic causes for the pain, such as a longitudinal split tear of the extensor pollicis brevis tendon [8].
Wrist position influences in vivo extensor pollicis brevis tendon excursion [33].
De Quervain tenosynovitis is associated with a significant decrease in maximum velocity during slow fist tasks [38].

Classification

The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis [31].
In cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [15].
De Quervain's syndrome may not be an isolated pathology and could be secondary to underlying wrist pathology due to previous trauma [9].
Post-traumatic de Quervain's syndrome is a rare condition that is often overlooked initially due to its rarity [10].
Styloid abnormalities, though considered a manifestation of de Quervain's disease by some authors, do not affect the outcome of management [11].
If diagnostic maneuvers for de Quervain tenosynovitis produce pain in a location other than the radial styloid, advanced imaging should be considered to identify other anatomic causes for the pain [8].
Routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data [5].
Addressing misconceptions about de Quervain's tenosynovitis regarding consequences and symptom duration allows patients to make informed decisions about treatment [3].
Longitudinal incision offers advantages including easy identification of the compartment, more complete release of the tendon sheath and peritendinous adhesions, and less risk of palmar subluxation of tendons [4].

Clinical Presentation

Anatomical variations in the first extensor compartment are clinically relevant to the pathophysiology of De Quervain's tenosynovitis [1].
De Quervain's syndrome may not be an isolated pathology and can be secondary to underlying wrist pathology due to previous trauma [9].
Diagnostic maneuvers for De Quervain tenosynovitis that produce pain in a location other than the radial styloid should prompt consideration of advanced imaging to identify other anatomic causes for the pain [8].
In cases with symptoms of De Quervain's syndrome where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [15].
The presence of an intracompartmental septum does not significantly affect clinical outcomes or complications following endoscopic release for De Quervain's syndrome [17].
More negative perceptions of the consequences of De Quervain's tenosynovitis are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [18].
Worse pain catastrophizing is associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of De Quervain's tenosynovitis [18].
Addressing misconceptions about the consequences for patients and the duration of symptoms allows patients to make informed decisions about treatment [3].
Using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with De Quervain's disease may lack validity [28].

Investigations

Anatomical variations in the first extensor compartment are clinically relevant to the pathophysiology and treatment of De Quervain's tenosynovitis [1].
Corticosteroid injection is the only nonsurgical treatment with evidence suggesting it can potentially modify the course of De Quervain's tenosynovitis [2].
Addressing patient misconceptions regarding symptom duration and consequences facilitates informed decision-making regarding treatment [3].
Surgical release of the first extensor compartment remains the gold standard treatment for De Quervain's tenosynovitis [4].
Longitudinal incision for surgical release allows for easy identification of the compartment, more complete release of the tendon sheath and peritendinous adhesions, and less risk of palmar subluxation of tendons [4].
Surgical release for refractory De Quervain's disease results in good clinical outcomes with minimal morbidity [12].
Diagnostic maneuvers for De Quervain's tenosynovitis producing pain in a location other than the radial styloid should prompt consideration of advanced imaging to identify other anatomic causes [8].
De Quervain's syndrome in some patients may be secondary to underlying wrist pathology due to previous trauma [9].
Post-traumatic De Quervain's syndrome is uncommon, often overlooked initially, but typically successfully treated non-operatively once diagnosed [10].
Styloid abnormalities, considered by some as a manifestation of De Quervain's disease, do not affect the outcome of management [11].
Ultrasound is a useful imaging technique for diagnosing De Quervain's disease and provides information about anatomic variations within the first extensor compartment [29].
Preoperative ultrasound is a worthwhile investigation in cases of De Quervain's disease [30].
Ultrasound-guided percutaneous release in De Quervain's disease is a safe and reliable procedure without specific morbidity [34].
Extensor pollicis brevis extension of the thumb interphalangeal joint is associated with a subcompartment of the first dorsal compartment, particularly in patients with De Quervain's disease [35].

Treatment

Non-Operative Management

Corticosteroid injection is the preferred initial nonsurgical treatment for de Quervain's tenosynovitis as it is the only available nonsurgical treatment that can potentially modify the course of the disease [2].
One or two local injections of 1 ml triamcinolone acetonide 10 mg/ml provided by general practitioners leads to short-term improvement in de Quervain's tenosynovitis when compared to placebo [22].
Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [13].
The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in only one small controlled clinical trial, which found steroid injections to be superior to thumb spica splinting [27].
Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease [24].
Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish [21].
Post-traumatic de Quervain's syndrome is typically successfully treated non-operatively once diagnosed [10].
Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [6].

Operative Management

Surgical release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity [12].
Endoscopic release of the extensor compartment is an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments, despite a slight increase in operation time [23].
One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments [32].
Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis, as the technique gives satisfactory medium-term results [7].

Preoperative Evaluation and Patient Factors

Styloid abnormalities do not affect the outcome of management of de Quervain's disease [11].
Deferring routine wrist radiography prior to surgeon evaluation does not affect management, as the practice is wasteful and patients do not benefit from the resulting radiologic data [5].
Addressing misconceptions about de Quervain's tenosynovitis regarding consequences and symptom duration allows patients to make informed decisions about treatment that matches their values [3].

Complications

Diagnostic maneuvers for De Quervain tenosynovitis producing pain in a location other than the radial styloid may indicate other anatomic causes for the pain, such as a longitudinal split tear of the extensor pollicis brevis tendon [8].
Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for De Quervain tenosynovitis compared to nondiabetic patients [21].
Neither heavy manual labor nor trauma could be shown to be predisposing risk factors for De Quervain's tenosynovitis [36].
Risk factors for De Quervain's in a young, active population include female gender, age greater than 40, and black race [37].

Recovery

Corticosteroid injection with a short duration of immobilization is the primary and effective treatment for de Quervain tenosynovitis [14].
Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year [26].
Endoscopic release for de Quervain's tenosynovitis provides earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release [25].
More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [18].

Key Evidence

[L4] These variations are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis. [1] (10.1016/j.bjps.2016.08.020)
[L4] According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment. [2] (10.1016/j.jhsa.2008.12.030)
[L3] Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. [3] (10.1097/corr.0000000000001577)
[L4] Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons. [4] (10.1007/s12306-018-0585-1)
[L3] The practice of obtaining routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data. [5] (10.1055/s-0037-1606124)
[L4] Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. [6] (10.1016/j.jhsg.2024.01.009)
[L4] The authors believe the technique gives satisfactory medium-term results and should be considered part of the surgical treatment for de Quervain tenosynovitis. [7] (10.1055/s-0035-1556862)
[L4] If diagnostic maneuvers for de Quervain tenosynovitis produce pain in a location other than the radial styloid, advanced imaging should be considered to identify other anatomic causes for the pain. [8] (10.1016/j.jhsa.2014.09.024)
[L4] The results suggest that de Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma. [9] (10.1177/1758998315599796)
[L4] Post-traumatic de Quervain's syndrome is very uncommon and often overlooked initially due to its rarity, but once diagnosed is typically successfully treated non-operatively. [10] (10.1177/1753193416646722)
[L4] Though considered as a manifestation of de Quervain's disease by some authors, styloid abnormalities do not affect the outcome of management as proved in this study. [11] (10.1007/s11552-010-9258-8)
[L4] The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity. [12] (10.4055/cios.2014.6.4.405)
[L3] This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. [13] (10.1177/1558944716681976)
[L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. [14] (10.1016/j.jhsa.2024.03.003)
[L4] In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised. [15] (10.2106/00004623-194931040-00019)
[L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. [17] (10.1177/17531934231214137)
[L3] More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. [18] (10.1097/corr.0000000000000992)
[L4] Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis. [19] (10.1016/j.jhsa.2023.07.005)
[L2] Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option. [20] (10.1016/j.jhsa.2021.04.018)
[L4] Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish. [21] (10.1016/j.jhsa.2022.02.018)
[L1] One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. [22] (10.1186/1471-2474-10-131)
[L4] Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments, despite a little increase in operation time. [23] (10.1016/j.bjps.2011.05.015)
[L1] Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease. [24] (10.1016/j.otsr.2019.11.015)
[L1] Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. [25] (10.1302/0301-620x.95b7.31486)
[L4] Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year. [26] (10.1007/s12593-009-0018-3)
[L1] The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in only one small controlled clinical trial, which found steroid injections to be superior to thumb spica splinting. [27] (10.1002/14651858.cd005616.pub2)
[L3] This finding may question the validity of using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease. [28] (10.1197/j.jht.2008.03.004)
[L5] Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment. [29] (10.1136/bcr-2021-242173)
[L4] Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease. [30] (10.1007/s12593-009-0001-z)
[L3] The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis. [31] (10.1177/1558944718810864)
[L4] One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. [32] (10.1016/j.aott.2018.10.004)
[L4] In vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. [33] (10.1016/j.jht.2017.12.004)
[L4] Ultrasound-guided percutaneous release in de Quervain's disease is a safe and reliable procedure without specific morbidity. [34] (10.1055/s-0039-1678688)
[L4] When it does, particularly in patients with de Quervain's disease, it is likely to reside in a subcompartment of the first dorsal compartment. [35] (10.1016/j.jhsa.2008.12.015)
[L3] Neither heavy manual labor nor trauma could be shown to be predisposing risk factors for de Quervain's tenosynovitis. [36] (10.1186/s12891-015-0579-1)
[L2] Risk factors for de Quervain's in our population include female gender, age greater than 40, and black race. [37] (10.1016/j.jhsa.2008.08.020)
[L3] Those subjects demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations that can occur in the setting of hand pathology. [38] (10.1177/1558944717729218)
[L2] The anatomical findings are consistent with previous studies, with an expectation to encounter the superficial branch of the radial nerve in more than 50% of patients. [45] (10.1055/s-0039-1688700)

References

[1] Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017. DOI: 10.1016/j.bjps.2016.08.020

[2] Nonsurgical Treatment for de Quervain's Tenosynovitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.030

[3] Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain’s Tenosynovitis?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001577

[4] Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients. MUSCULOSKELETAL SURGERY. 2019. DOI: 10.1007/s12306-018-0585-1

[5] Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients. Journal of Wrist Surgery. 2017. DOI: 10.1055/s-0037-1606124

[6] De Quervain’s Tenosynovitis: As Seen from the Perspective of the Patient. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.009

[7] Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results. Journal of Wrist Surgery. 2015. DOI: 10.1055/s-0035-1556862

[8] Longitudinal Split Tear of the Extensor Pollicis Brevis Tendon: Report of 2 Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.09.024

[9] De Quervain’s syndrome: It may not be an isolated pathology. Hand Therapy. 2015. DOI: 10.1177/1758998315599796

[10] Post-traumatic de Quervain’s syndrome: a rare condition, often diagnosed late. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416646722

[11] Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?. HAND. 2010. DOI: 10.1007/s11552-010-9258-8

[12] Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores. Clinics in Orthopedic Surgery. 2014. DOI: 10.4055/cios.2014.6.4.405

[13] Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis. HAND. 2016. DOI: 10.1177/1558944716681976

[14] Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.003

[15] AN UNUSUAL FORM OF DE QUERVAINʼS SYNDROME. The Journal of Bone & Joint Surgery. 1949. DOI: 10.2106/00004623-194931040-00019

[17] Prediction of an intracompartmental septum and its effect on outcomes of endoscopic release for de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231214137

[18] Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain’s Tenosynovitis? A Cross-sectional Study. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000992

[19] Association of Patient-Reported Outcomes Measurement Information System Measures With Injection and Surgical Treatment Response in Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.005

[20] De Quervain Tenosynovitis: An Evaluation of the Epidemiology and Utility of Multiple Injections Using a National Database. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.018

[21] Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.02.018

[22] Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-131

[23] Does endoscopic release of the first extensor compartment have benefits over open release in de Quervain’s disease?. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2011. DOI: 10.1016/j.bjps.2011.05.015

[24] Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2019.11.015

[25] Endoscopicversusopen release in patients with de Quervain’s tenosynovitis. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b7.31486

[26] Patient-centered care of de Quervain’s disease. Journal of Hand and Microsurgery. 2009. DOI: 10.1007/s12593-009-0018-3

[27] Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database of Systematic Reviews. 2009. DOI: 10.1002/14651858.cd005616.pub2

[28] Bilateral_Thu_mb's_Active_Range_of_Motion_and_Strength_in_de_Quervain's_Disease_S0894113008000483. Journal of Hand Therapy. 2008. DOI: 10.1197/j.jht.2008.03.004

[29] Type II de Quervain’s disease: depicting subcompartmentalisation with ultrasound. BMJ Case Reports. 2021. DOI: 10.1136/bcr-2021-242173

[30] Preoperative ultrasound in de Quervain’s disease: an investigation worth doing. Journal of Hand and Microsurgery. 2009. DOI: 10.1007/s12593-009-0001-z

[31] Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study. HAND. 2018. DOI: 10.1177/1558944718810864

[32] One portal endoscopic release of the first extensor compartment in de Quervain's disease. Acta Orthopaedica et Traumatologica Turcica. 2020. DOI: 10.1016/j.aott.2018.10.004

[33] Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.12.004

[34] Ultrasound-Guided de Quervain's Tendon Release, Feasibility, and First Outcomes. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1678688

[35] Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.015

[36] Work related etiology of de Quervain’s tenosynovitis: a case-control study with prospectively collected data. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0579-1

[37] Incidence of de Quervain's Tenosynovitis in a Young, Active Population. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.08.020

[38] Dynamic Functional Assessment of Hand Motion Using an Animation Glove: The Effect of Stenosing Tenosynovitis. HAND. 2017. DOI: 10.1177/1558944717729218

[45] A Prospective Evaluation of the Anatomy of the First Dorsal Compartment in Patients Requiring Surgery for De Quervain's Tenosynovitis. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688700