Jnl Wrist Surg 2018; 07(01): 031-037
DOI: 10.1055/s-0037-1603686
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulley Reconstruction for Symptomatic Instability of the Tendons of the First Extensor Compartment Following de Quervain's Release

Daan Renson
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Koen Mermuys
2  Department of Radiology, AZ Sint-Jan AV Brugge-Oostende, Campus Brugge, Bruges, Belgium
,
Bert Vanmierlo
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Francis Bonte
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Petrus Van Hoonacker
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Diederick Kerckhove
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Bart Berghs
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
,
Jean F. Goubau
1  Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic Brugge, AZ Sint-Jan AV Brugge–AZ Sint Lucas, Bruges, Belgium
3  Department of Orthopaedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel, Jette, Belgium
› Author Affiliations
Funding None.
Further Information

Publication History

14 October 2016

02 May 2017

Publication Date:
07 June 2017 (eFirst)

Abstract

Background Surgical management of de Quervain's tenosynovitis is based on decompression of the first extensor compartment. A simple release of the first compartment can cause instability of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons in zone seven of the extensors. The WHAT test (wrist hyperflexion and abduction of the thumb) is very effective in diagnosing this instability.

Patients and Methods In this retrospective monocentric study, we analyzed a case series of 10 patients all of whom underwent a reconstruction of the first extensor compartment using a retinacular graft because of symptomatic instability after decompression surgery. The reconstruction was a modified technique of the sixth compartment. Functional outcome and characteristics of the newly reconstructed pulley were examined by physical examination with the aid of ultrasound and internationally validated questionnaires.

Results Four patients had a good-to-excellent functional outcome, all of those had a maximum of two surgical procedures performed on the first extensor compartment. Six patients presented poor functional outcome. In four of them, more than two surgical procedures were performed. Minor residual instability was noted in six cases, found in both the groups.

Conclusion The reconstruction procedures on the first compartment seemed to be satisfactory in treating instability of the EPB and APL tendons after primary surgical release for de Quervain's disease.

Level of Evidence Level IV, observational study without controls.