Tenossinovite de De Quervain Folheto

O que você está sentindo

Provavelmente, você sente dor na parte externa do pulso, próxima à base do polegar. Essa área é chamada de apófise estilóide radial. A dor resulta da inflamação nos tendões que movem o polegar. Você pode notar inchaço ou uma sensação de tensão nesse local.

A dor frequentemente piora quando você move o polegar ou o pulso. Tarefas diárias simples podem se tornar difíceis. Você pode ter dificuldade para segurar objetos, levantar uma xícara de café ou girar uma chave. Estender o braço para trás para fechar o fecho de um sutiã pode ser doloroso. Enfiar a camisa dentro da calça também pode desencadear desconforto. Se você dorme do lado afetado, a dor pode impedir que você adormeça ou acordá-lo.

Algumas pessoas sentem dor logo ao acordar pela manhã. Outras notam que a dor se intensifica após usar a mão por um período. Se você teve uma lesão prévia no pulso, essa condição pode estar relacionada a esse trauma. Ela também é mais comum durante a gravidez.

Se a dor estiver em um local diferente da base do polegar, ela pode ser causada por outra condição. Em casos raros, os tendões podem prender ou travar. Isso é conhecido como dedo em gatilho. Se isso acontecer, a cirurgia é frequentemente necessária para corrigir o problema. No entanto, a maioria das pessoas inicia com tratamentos não cirúrgicos primeiro.

Seu cirurgião verificará esses sintomas específicos para confirmar o diagnóstico. Ele pode pedir que você mova o polegar de certas maneiras para verificar se isso causa dor. Abordar suas preocupações sobre a duração desse quadro pode ajudá-lo a decidir sobre o melhor tratamento para você.

O que está realmente acontecendo

A tenossinovite de De Quervain é uma condição de desgaste que afeta os tendões no lado radial do seu pulso. Os tendões são cordas resistentes e semelhantes a cordas que conectam seus músculos aos seus ossos. Eles permitem que você mova seu polegar e pulso suavemente.

Esses tendões passam por um túnel apertado chamado bainha. Pense nesta bainha como uma manga protetora ou uma junta que mantém o tendão no lugar. Na doença de De Quervain, esta manga torna-se inflamada e inchada. O inchaço torna o espaço dentro do túnel mais apertado do que deveria ser.

Quando você tenta mover seu polegar ou pulso, o tendão inchado esfrega contra as paredes apertadas da bainha. Esta fricção causa dor, inchaço e uma sensação de travamento. Você pode sentir uma sensação de atrito ou estalo quando move a mão. Isso ocorre porque o tendão está com dificuldade para deslizar pelo túnel estreitado.

A dor geralmente está localizada no estiloide radial, que é o proeminência óssea no lado radial do seu pulso. Se você pressionar esta área, ela frequentemente fica sensível. Você também pode notar rigidez nas articulações do seu polegar, embora isso seja raro.

Às vezes, a dor pode parecer estar vindo de um local diferente. Se a sua dor não estiver exatamente no estiloide radial, seu cirurgião pode procurar outras causas. Condições como um ventre muscular extra ou inflamação nos compartimentos tendinosos próximos podem imitar a doença de De Quervain. Utilizamos imagens, como ultrassonografia ou ressonância magnética, para visualizar claramente os tecidos moles. A ultrassonografia é particularmente boa em mostrar a anatomia do primeiro compartimento extensor onde esses tendões estão localizados.

Compreender o que está acontecendo ajuda você a tomar decisões informadas. Você pode optar por tratamentos não operatórios primeiro, como repouso ou injeções de corticosteroides. Essas injeções podem reduzir a inflamação e modificar o curso da condição. Se os sintomas persistirem, a liberação cirúrgica pode ser considerada para alargar o túnel e aliviar a pressão sobre o tendão.

O que podemos fazer a respeito

A forma como o Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, aborda este tema na nossa clínica reflete um caminho claro: os pacientes chegam até nós por meio de encaminhamento do clínico geral ou fisioterapeuta. Uma avaliação clínica (histórico, exame físico e imagens quando necessário) estabelece o diagnóstico. Para problemas degenerativos ou de longa data, geralmente tentamos tratamento não operatório — modificação da atividade, fisioterapia ou terapia manual, uso de órtese e injeções — e consideramos a cirurgia quando isso não proporciona melhora suficiente. Para problemas estruturais ou agudos, a cirurgia pode ser recomendada imediatamente, sem uma tentativa prévia de tratamento não operatório.

Você pode começar alterando a forma como usa a mão. Evite movimentos que pressionem ou torçam o polegar, como levantar uma panela pesada pelo cabo. Seu fisioterapeuta pode orientá-lo por meio de alongamentos suaves para manter os tendões deslizando suavemente. Também recomendamos o uso de uma órtese para o polegar para repousar a área. Esse suporte simples ajuda a reduzir a tensão enquanto a inflamação se resolve. Dê algumas semanas a essas medidas para surtir efeito. Se a dor persistir, avançamos para a próxima etapa.

O manejo médico concentra-se na redução do inchaço e da dor. O tratamento inicial preferido é uma injeção de corticosteroide na bainha do tendão. Esta é a única opção não cirúrgica que pode potencialmente alterar o curso da condição. Ela atua acalmando a inflamação diretamente na origem. Para muitos pacientes, uma ou duas injeções proporcionam alívio significativo. As evidências mostram que as injeções de corticosteroide levam ao sucesso do tratamento em 73,4% dos casos em até 2 injeções. Em alguns casos, uma única injeção foi eficaz para aliviar os sintomas em 82% dos pacientes, com mais da metade permanecendo assintomática por pelo menos 12 meses. Combinamos isso com um curto período de imobilização para ajudar o tendão a cicatrizar. Se você tem diabetes, observe que tem uma probabilidade reduzida de sucesso após uma única injeção em comparação com pacientes não diabéticos. No entanto, a eficácia de cada injeção adicional não parece diminuir em pacientes diabéticos.

A cirurgia é considerada quando o tratamento conservativo atingiu seu limite. Isso é raro, pois a maioria dos casos melhora sem ele. A liberação cirúrgica é tipicamente reservada para o gatilho (trigger finger), uma condição rara em que o tendão fica preso, ou quando as injeções não proporcionam alívio duradouro. O procedimento envolve a liberação da bainha apertada ao redor do tendão para permitir que ele deslize livremente. Discutimos essa opção com você apenas após os métodos não operatórios terem sido esgotados ou se a sua anatomia específica exigir.

O que esperar

A tenossinovite de De Quervain é uma condição na qual os tendões do lado do seu pulso se inflamam. A maioria das pessoas considera que iniciar com cuidados não cirúrgicos é a melhor primeira etapa. O tratamento inicial preferido é uma injeção de corticosteroides na área afetada. Esta é a única opção não cirúrgica que pode alterar o curso da condição.

Quando você recebe esta injeção, ela é frequentemente combinada com um curto período de repouso para o seu pulso. Esta abordagem é eficaz para muitos pacientes. De fato, o tratamento tem sucesso em 73,4% dos casos dentro de duas injeções. Se você tem diabetes, sua chance de sucesso com uma única injeção pode ser menor do que para aqueles sem diabetes. No entanto, injeções adicionais permanecem eficazes para você também.

Se as injeções não proporcionarem alívio duradouro, a cirurgia pode ser considerada. É importante saber que nem todos precisam de cirurgia. Apenas 34,9% dos pacientes com novos sintomas precisaram de cirurgia dentro de um período de acompanhamento de dois anos. A maioria dos pacientes que progrediu para a cirurgia o fez dentro de um ano de sua primeira consulta. Você tem mais probabilidade de precisar de cirurgia se sua dor interferir significativamente na vida diária ou se suas pontuações de função física forem baixas.

Para aqueles que passam pela cirurgia, o prognóstico é geralmente positivo. A liberação endoscópica, uma técnica minimamente invasiva, frequentemente proporciona melhora mais precoce do que a cirurgia aberta tradicional. Ela também tende a resultar em menos complicações nervosas e melhor satisfação com a cicatriz. Embora a taxa de sucesso do tratamento possa diminuir com injeções múltiplas, injeções repetidas permanecem uma opção viável com uma alta taxa de sucesso.

Seus sintomas podem persistir se não forem tratados, mas também podem se resolver com os cuidados adequados. Abordar quaisquer equívocos sobre quanto tempo isso dura ajuda você a tomar decisões informadas. Seu cirurgião irá ajudá-lo a escolher o caminho que melhor se alinha com seus valores e estilo de vida.

Quando procurar ajuda médica

Consulte o seu médico de família se tiver dor persistente no lado radial do pulso que não melhora com o repouso. Solicite uma avaliação especializada se notar fraqueza, instabilidade ou se o polexo travar ou ceder. Os sintomas que interferem com o sono ou com o trabalho também justificam uma avaliação. Se os exames diagnósticos provocarem dor numa localização diferente da apófise estilóide radial, poderá ser necessária uma imagem avançada para identificar outras causas. Embora as injeções de corticosteroides ajudem 73,4% dos pacientes em até duas aplicações, uma avaliação precoce garante que receba o tratamento adequado. Abordamos equívocos comuns para ajudá-lo a tomar decisões informadas sobre a sua recuperação.

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

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