First Dorsal Extensor Compartment Release

First Dorsal Extensor Compartment Release

Loukia K. Papatheodorou, MD, PhD

Aaron I. Venouziou, MD

Filippos S. Giannoulis, MD, PhD

Dean G. Sotereanos, MD

Dr. Sotereanos or an immediate family member serves as a paid consultant to or is an employee of Arthrex, Inc., AxoGen Inc., and Smith & Nephew. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter: Dr. Papatheodorou, Dr. Venouziou, and Dr. Giannoulis.


de Quervain syndrome is stenosing tenosynovitis of the first dorsal extensor compartment of the wrist. The first dorsal extensor compartment contains the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) tendons. The condition is named for the Swiss surgeon Fritz de Quervain, who, in 1895, described a painful condition involving the APL and the EPB tendon sheaths at the radial styloid process. de Quervain recommended simple release of the stenotic extensor retinaculum. In 1927, Finkelstein described the physical examination maneuver that bears his name and recommended excising a portion of the sheath when it is excessively thickened or cartilaginous in nature. Subsequently, authors have recommended various treatment approaches, including splinting, injections, limited retinaculum release, extensive retinaculum release, and retinaculum excision.1


Any patient with de Quervain tenosynovitis in whom nonsurgical treatment of splinting and/or steroid injections has failed is a candidate for surgical release of the first dorsal compartment. Patients with de Quervain tenosynovitis present with radial-sided wrist pain. The pain is exacerbated by wrist motion, particularly radial to ulnar deviation, thumb movement, especially thumb abduction and/or extension, and pain may radiate distally or proximally along the course of the APL and EPB tendons. Recent epidemiologic studies have demonstrated that risk factors for de Quervain syndrome include female sex (occurs 6 up to 10 times more frequently in females than in males), age greater than 40 years, and black race.2,3 The condition has also been noted to commonly present in pregnant and lactating women.

Physical examination often reveals localized swelling and tenderness over the first dorsal compartment, extending 1 to 2 cm proximal to the radial styloid process. In 1930, Finkelstein4 described a clinical test that is pathognomonic of the disease. The test result is positive when excruciating pain over the styloid tip is generated by grasping the patient’s thumb and quickly abducting the hand ulnarward. Anatomically, the musculotendinous junction of the EPB tendon is close to the first compartment. In the Finkelstein test, when the thumb is in full flexion and the wrist is in ulnar deviation, the EPB muscle belly is pulled into the first compartment, resulting in a bulk effect. The synovial tissue around the EPB and APL tendons also might be stretched in the Finkelstein testing position, causing a tethering effect. Both bulk and tethering effects may induce pain by directly stretching synovial tissue, especially when the synovial tissue is inflamed or fibrotic, as may be the case in de Quervain disease.5


Radiographs consisting of PA and lateral views of the wrist as well as a hyperpronated thumb view, known as a Roberts view (Figure 1), are used to differentiate de Quervain tenosynovitis from other arthritic conditions. Radiographic study should exclude arthritis of the thumb carpometacarpal joint, although this condition may coexist; scaphoid fracture; and arthrosis involving the radiocarpal or intercarpal joints.

image VIDEO 39.1 First Dorsal Extensor Compartment Release. Filippos Giannoulis, MD; Douglas S. Musgrave, MD; Alexander H. Payatakes, MD; Dean Sotereanos, MD (3 min)

Feb 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on First Dorsal Extensor Compartment Release

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