gms | German Medical Science

Objectives/Interrogation: De Quervain's tenosynovitis is one of the common causes of radial wrist pain resulting from thickening of the fibro-osseous sheath of the first extensor compartment. Surgical release of the compartment is indicated when non-operative treatment fails. We have reported earlier improvement and less complications after endoscopic release of the compartment in patients with de Quervain's disease, when compared with open release. However, there are lack of evidences of benefits and risks of the endoscopic technique for de Quervain's disease over the open technique. Thus, we have retrospectively reviewed patients who underwent endoscopic release for de Quervain's disease with minimum follow-up of 12 months.

Methods: Between Apr 2009 and Jan 2017, this retrospective study enrolled consecutive patients with de Quervain's tenosynovitis who underwent endoscopic release of first extensor compartment and followed-up minimum of 1 year. Patients fulfilling the following criteria were excluded: (1) concomitant osteoarthritis of TM joint or STT joint, (2) concomitant Wartenberg syndrome, (3) underlying chronic inflammatory disease like rheumatoid arthritis or gouty arthritis, and (4) inadequate follow-up. For clinical assessment, VAS pain score, pinch strength and DASH score were assessed preoperatively and postoperatively, and VAS satisfaction score for postoperative scar was also evaluated. Complications were reviewed such as neurovascular injury, postoperative infection, unrelieved pain, and redo surgery.

Results and Conclusions: One hundred sixty eight patients(181 wrists) were included and their mean age was 49.2±14.3 years. Among them, 96.4% (162 patients) were female. Dominant wrist was involved in 67.4% (122 wrists). The mean follow-up period after surgery was 17.6 months. The mean VAS pain score and DASH score improved from 7.1±1.7 to 1.2±1.3 and from 52.4±21.5 to 5.6±4.7. The mean pinch strength improved from 5.0±2.4 kg to 6.6±2.5 kg. The mean VAS satisfaction score for postoperative scar was 8.2±1.2 (higher score representing greater satisfaction). Twelve patients had transient superficial radial nerve symptom (5.49%) postoperatively and resolved spontaneously within 6 weeks in all patients. One patient underwent open tenolysis due to unrelieved pain after endoscopic release.

This study showed that the endoscopic release for the first extensor compartment seems to be effective and safe procedure for patients with de Quervain's tenosynovitis when conservative treatment fails.