Ultrasonographic evaluation of anatomical variations, of the first dorsal compartment of wrist, and its correlation with de Quervain’s disease recurrence in Indian population: a hospital based longitudinal study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232155Keywords:
De Quervain's tenosynovitis, Radial sided wrist pain, First dorsal compartment of wristAbstract
Background: de Quervain’s disease is a commonly encountered debilitating condition mostly treated conservatively. Cadaveric studies have revealed anatomical variations in the first dorsal compartment of the wrist; however, a causal association between the variants and recurrence of the disease has not been established. An ultrasonographic assessment of the first dorsal compartment of the wrist was done, to correlate the response to treatment, of the different anatomical variants.
Methods: 106 wrists were included in the study after clinically confirming de Quervain’s disease. All were injected with 20mg of methylprednisolone acetate in the first dorsal compartment of the wrist and were followed up. Patients who were pain free for at least six months, as well as patients who did not respond or had a recurrence of disease within eight to twelve weeks, were all assessed with ultrasound.
Results: 57.54% of the wrists were cured with one injection most of which revealed a tendon arrangement of one abductor pollicis longus (APL) and one extensor pollicis brevis (EPB) and two APL and one EPB without any septation. 32.07% of the wrists did not respond to this treatment and most of them comprised of septations and aberrant compartments with presence of supernumerary tendons.
Conclusions: Ultrasonographic assessment of the first dorsal compartment of wrist, of all patients suffering from de Quervain’s tenosynovitis must be done to predict the outcome of conservative therapy and customize an optimal treatment modality for the individual anatomical variant.
References
Anson BJ. An atlas of human anatomy, 2nd edition. Saunders, Philadelphia. 1963.
Baba MA. The accessory tendon of the abductor pollicis longus muscle. Anat Rec. 1954;119:541-7.
Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain's disease. A study of operative findings. Int Orthop. 1995;19(4):209-11.
Bouchlis G, Bhatia A, Asfazadourian H, Touam C, Vacher C, Oberlin C. Distal insertions of abductor pollicis longus muscle and arthritis of the first carpometacarpal joint in 104 dissections. Ann Chir Main Memb Super. 1997;16(4):326-38.
Brown GD 3rd, Roh MS, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. J Hand Surg. 2003;28(5):739-43.
Brunelli GA, Brunelli GR. Anatomical study of distal insertion of the abductor pollicis longus. Concept of a new musculo tendinous unit: the abductor carpi muscle. Ann Chir Main Memb Super. 1991;10(6):569-76.
Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg. 1973;55(8):1655-66.
Finkelstein H. Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg. 1930;12:509-40.
Lomis LK. Variations of stenosing tenosynovitis at the radial styloid process. J Bone Joint Surg. 1951;33-A:340-6.
Muckart RD. Stenosing tendovaginitis of abductor pollicis longus and extensor pollicis brevis at the radial styloid (de Quervain's disease). Clin Orthop. 1964;33:201-8.
Zancolli EA. The trapeziometacarpal joint. Tenotomy of the accessory tendons in early osteoarthritis. Hand Clin. 2001;17(1):13-43.
Saehle T, Sande S, Finsen V. Abductor pollicis longus tendon interposition for arthrosis in the fi rst carpometacarpal joint: 55 thumbs reviewed after 3 (1–5) years. Acta Orthop Scand. 2002;73(6):674-7.
Rousset P, Vuillemin-Bodaghi V, Laredo JD, Parlier-Cuau C. Anatomic variation in the first extensor compartment of the wrist: accuracy of US. Radiology. 2010;257(2):427-33.
Yuasa K, Kiyoshige Y. Limited surgical treatment of de Quervain's disease: decompression of only the extensor pollicis brevis sub compartment. J Hand Surg [Am]. 1998;23(5):840-3.
Zingas C, Failla JM, Holsbeeck MV. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg. 1998;23(1):89-96.
Nayak SR, Hussein M, Krishnamurthy A. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J. 2009;32(6):600-4.
Cho KO. Translocation of the abductor pollicis longus tendon. A treatment for chronic subluxation of the thumb carpometacarpal joint. J Bone Joint Surg Am. 1970;52(6):1166-70.
Dos Remédios C, Chapnikoff D, Wavreille G, Chantelot C, Migaud H, Fontaine C. The abductor pollicis longus: relation between innervation, muscle bellies and number of tendinous slips. Surg Radiol Anat. 2005;27(3):243-8.
Bianchi S, Martinoli C, Abdelwahab IF. High-frequency ultrasound examination of the wrist and hand. Skeletal Radiol. 1999;28(3):121-9.
Leslie BM, Ericson WB Jr, Morehead JR. Incidence of a septum within the first dorsal compartment of the wrist. J Hand Surg [Am]. 1990;15(1):88-91.
Azar FM, Beaty JH, Canale ST. Campbell’s operative orthopaedics. Philadelphia, PA: Elsevier. 2017;3765-6.
Roy AJ, Roy AN, De C, Banerji D, Das S, Chatterjee B, et al. A cadaveric study of the first dorsal compartment of the wrist and its content tendons: anatomical variations in the Indian population. J Hand Microsurg. 2012;4(2):55-9.
Mallick SK, Jha DK, Majumdar A, Mahapatra S. A Comparative Study between Splinting Versus Corticosteroid Injection in De-Quervain’s Disease. Int J Orthop Sci. 2018;4(3):22-6.
Cheong IY, Rhyu IJ, Kim KH, Chung PW, Kim D, Park BK, et al. Anatomical Basis for Injection around First Dorsal Compartment of the Wrist: A Fresh Cadaveric Study. Pain Physician. 2016;19(6):E893-900.
