德奎尔万腱鞘炎 资料
您的感受
您可能会感到手腕外侧、拇指根部附近疼痛。该区域称为桡骨茎突。疼痛源于控制拇指活动的肌腱发炎。您可能会注意到该部位出现肿胀或紧绷感。
当您活动拇指或手腕时,疼痛通常会加重。简单的日常任务可能会变得困难。您可能难以抓握物体、端起咖啡杯或转动钥匙。将手伸到背后扣内衣可能会引起疼痛。塞衬衫下摆也可能引发不适。如果您侧卧在患侧睡觉,疼痛可能会影响入睡或导致夜间醒来。
有些人会在早晨刚醒来时感到疼痛。另一些人则注意到在用手一段时间后疼痛会加剧。如果您手腕曾受过伤,这种情况可能与那次创伤有关。这种情况在孕期也更为常见。
如果疼痛位置不在拇指根部,则可能由其他原因引起。在极少数情况下,肌腱可能会卡住或锁住。这称为扳机指(triggering)。如果出现这种情况,通常需要通过手术进行矫正。然而,大多数人会首先接受非手术治疗。
您的外科医生会检查这些特定症状以确诊。他们可能会要求您以特定方式活动拇指,以观察是否会引起疼痛。解决您对病程持续时间的担忧,有助于您决定最适合您的治疗方案。
实际发生了什么
De Quervain腱鞘炎是一种影响手腕拇指侧肌腱的磨损性疾病。肌腱是连接肌肉与骨骼的坚韧、绳索状组织。它们使拇指和手腕能够平滑运动。
这些肌腱穿过一个狭窄的隧道,称为腱鞘。可以将腱鞘想象为保护套或垫片,用于固定肌腱。在De Quervain腱鞘炎中,该保护套发生炎症和肿胀。肿胀使隧道内部空间比正常情况更狭窄。
当您尝试活动拇指或手腕时,肿胀的肌腱会与腱鞘狭窄的壁发生摩擦。这种摩擦会导致疼痛、肿胀和卡顿感。活动手部时,您可能会感到研磨或弹响的感觉。这是因为肌腱在狭窄的隧道中滑动困难所致。
疼痛通常位于桡骨茎突,即手腕拇指侧的骨性突起。按压该区域时,通常会有压痛。您可能还会注意到拇指关节僵硬,但这种情况较为罕见。
有时,疼痛可能感觉来自其他部位。如果疼痛不在桡骨茎突处,外科医生可能会寻找其他病因。诸如额外的肌腹或邻近肌腱隔室的炎症等疾病可能模拟De Quervain腱鞘炎的症状。我们使用影像学检查(如超声或MRI)来清晰观察软组织。超声在显示这些肌腱所在的第一个伸肌隔解剖结构方面尤为有效。
了解实际发生的病理变化有助于您做出明智的决策。您可能首先选择非手术治疗,如休息或皮质类固醇注射。这些注射可以减少炎症并改变疾病的进程。如果症状持续存在,则可能考虑手术松解,以加宽隧道并减轻对肌腱的压力。
我们能采取的措施
基兰·希尔帕拉(Kieran Hirpara)医生作为麦特私人医院(Mater Private Hospital Rockhampton)的上肢外科医生,在门诊中采用的方法体现了一条清晰的诊疗路径:患者通过全科医生或物理治疗师转诊至我们处。门诊评估(包括病史采集、体格检查以及必要的影像学检查)确立诊断。对于退行性或长期存在的问题,我们通常先尝试非手术治疗——包括调整活动方式、物理治疗或手部治疗、夹板固定和注射治疗——若改善不足再考虑手术。对于结构性或急性问题,则可能直接建议手术,无需先进行非手术治疗试验。
您可以从改变手部使用方式开始。避免使拇指受到挤压或扭转的动作,例如不要通过手柄提起沉重的锅具。您的物理治疗师可能会指导您进行轻柔的拉伸练习,以保持肌腱顺畅滑动。我们还建议佩戴拇指夹板以休息患处。这种简单的支撑有助于在炎症消退期间减轻负担。请给这些措施几周时间以发挥作用。如果疼痛持续存在,我们将进入下一步治疗。
药物治疗侧重于减轻肿胀和疼痛。首选的初始治疗是向腱鞘内注射皮质类固醇。这是唯一一种可能改变疾病进程的非手术选项。它通过直接在源头抑制炎症来发挥作用。对于许多患者,一次或两次注射即可提供显著缓解。证据表明,在两次注射内,皮质类固醇注射的治疗成功率为 73.4%。在某些情况下,单次注射即可在 82% 的患者中有效缓解症状,其中超过一半的患者在至少 12 个月内保持无症状。我们将此与短期的制动相结合,以帮助肌腱愈合。如果您患有糖尿病,请注意,与非糖尿病患者相比,单次注射后的成功率较低。然而,在糖尿病患者中,每次额外注射的有效性似乎并未降低。
当保守治疗达到极限时,才会考虑手术。这种情况很少见,因为大多数病例无需手术即可改善。手术松解通常仅用于腱鞘狭窄症(tenosynovitis,一种罕见的肌腱卡压情况)或注射未能提供持久缓解时。该手术涉及松解肌腱周围紧绷的腱鞘,使其能够自由滑动。我们仅在非手术方法已用尽或您的特定解剖结构需要时才与您讨论此选项。
预期情况
De Quervain腱鞘炎是指手腕侧面的肌腱发生炎症。大多数患者发现,首先采取非手术治疗是最佳的第一步。首选的初始治疗是向受影响区域注射皮质类固醇。这是唯一能够改变疾病进程的非手术选项。
接受注射时,通常建议手腕短期休息。这种方法对许多患者有效。事实上,在两次注射内,治疗的成功率为73.4%。如果您患有糖尿病,单次注射的成功率可能低于非糖尿病患者。然而,额外的注射对您同样有效。
如果注射不能提供持久的缓解,可能会考虑手术。重要的是要知道,并非所有人都需要手术。在两年的随访期内,只有34.9%的新发症状患者需要手术。大多数进展到手术阶段的患者是在首次就诊后一年内进行手术的。如果您的疼痛严重干扰日常生活,或者您的身体功能评分较低,则更可能需要手术。
对于接受手术的患者,总体预后通常良好。内镜下松解术是一种微创技术,通常比传统开放手术能更早改善症状。它往往导致更少的神经并发症和更好的疤痕满意度。虽然多次注射可能会降低治疗成功率,但重复注射仍然是一个可行的选择,且成功率很高。
如果不进行治疗,您的症状可能会持续存在,但在适当护理下也可以缓解。澄清关于此病持续时间的任何误解,有助于您做出明智的决定。您的外科医生将帮助您选择最符合您价值观和生活方式的治疗路径。
何时就诊
如果您的拇指侧手腕持续疼痛且休息后无改善,请咨询您的全科医生。如果您注意到无力、不稳定或拇指出现锁定或无力感,请要求专科医生进行评估。影响睡眠或工作的症状也需要进行评估。如果诊断测试在桡骨茎突以外的部位引起疼痛,则可能需要高级影像学检查以查找其他病因。虽然皮质类固醇注射在两次治疗后对 73.4% 的患者有效,但早期评估可确保您获得适当的治疗。我们澄清误解,以帮助您就康复做出明智的决定。
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)
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