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Depiction of the different types of skin incisions used to perform an open release. a-c, transverse incision, longitudinal incision, and an oblique incision. reprinted with permission from esser Masterclass.
Source publication
Background:
Surgical release of the extensor retinaculum is performed as a treatment for de Quervain's (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic revi...
Contexts in source publication
Context 1
... gliding, different types of lengthening of the retinaculum, and resection of a part of the retinaculum. The types of incision reported were transverse (n = 14), longitudinal (n = 4), and oblique (n = 3) (Fig. 2). Two articles did not report the incision type. 25,30 ...
Citations
... Female gender, age between 35 and 55, pregnancy, and repetitive manual work are risk factors for developing de Quervain's tenosynovitis. [1] It is characterized by pain, tenderness, and swelling around the lateral aspect of the wrist resulting from inflammation of the common sheath of abductor pollicis longus and extensor pollicis brevis tendons. [2] The abductor pollicis longus does the abduction and extension of the thumb whereas the extensor pollicis brevis extends the proximal phalanx and the metacarpal bone of the thumb and both of them are innervated by the deep branch of radial nerve originating from C 7 and C 8 nerve roots. ...
De Quervain’s tenosynovitis is a painful condition in which common tendon sheath of abductor pollicis longus and extensor pollicis brevis is inflamed or thickened, about 3.25 cm proximal to the tip of radial styloid process on the lateral aspect of wrist. It leads to narrowing of the intrathecal lumen.[i] It can result due to repetitive stress, hormonal influence, rheumatoid disease, trauma or degenerative changes. Females are more affected than males. The clinical features include pain on lateral aspect of wrist that is increased on extension and abduction movements of the thumb. Pain may progress in severity to an extent of significant disability. Splinting of the thumb, injection of corticosteroids into the tendon sheath and surgical release of the first dorsal compartment are adopted in the contemporary medical science to manage it. In Ayurveda, the infliction of Ruja (pain) and Karma Kshaya (diminution in the normal activity/disability) has been attributed to vitiation of Vata Dosha. Excessively painful conditions of bones, joints, muscles, tendons and ligaments constitute the indications for Agnikarma (therapeutic heating). In this case study, a 52 years old female who was a housewife, visited the outdoor patient department (OPD) of Shalya Tantra at hospital of National Institute of Ayurveda (NIA), Jaipur, Rajasthan, India. She presented with the chief complaints of having severe pain at the radial side of the right wrist with difficulty in performing household work for the last six months. On palpation, there was tenderness at the site with a feebly palpable swelling. The Finkelstein’s test was positive. This case was managed with conductive method of Agnikarma using a Swarna Shalaka (rod made up of 14 K gold) with positive outcomes. This case study is presented here to emphasize the applicability of a traditional pain management therapy viz. Agnikarma in modern clinical practice.
Background
A significant proportion of patients still report pain following a surgical release for de Quervain disease (DQ). This study aimed to investigate the effectiveness of a surgical release for DQ and to identify the preoperative factors associated with pain after a surgical release for DQ.
Methods
This prospective cohort study includes 707 patients who underwent a surgical release and completed the Visual Analog Scale Questionnaire (VAS, range 0-100). We used a paired t-test to analyse the effectiveness of the surgical release on pain at three months post-operatively compared to the pre-operatively measured outcome. A hierarchical multivariable linear regression model was created to investigate the contribution of the patient- and disease characteristics to post-operative pain.
Results
All VAS domains showed improvement after surgical release. On average, the mean VAS pain decreased by 44 points (95% CI 42; 46). Smoking (B=6.37; p<0.01), younger age (B=-0.35; p<0.01), longer duration of complaints (B=0.13; p<0.01), concomitant surgery (B=14.40; p<0.01) and higher VAS pain scores at intake (B=0.15; p<0.01) were associated with worse VAS pain scores post-operatively. Together, the variables explained 11% of the variance in mean VAS pain score at three months of follow-up.
Conclusion
This study confirms that surgical treatment for patients with DQ significantly reduces patient-reported pain. Smoking, younger age, concomitant surgery, duration of complaints, and higher VAS pain scores at intake are associated with worse patient-reported pain three months after surgical release. However, the small effects suggest that these factors should not be considered the only important factors.
Level of Evidence
Therapeutic, II.
Importance
There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.
Objective
To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.
Data Sources
Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.
Study Selection
All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.
Data Extraction and Synthesis
This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.
Main Outcomes and Measures
Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.
Results
A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.
Conclusions and Relevance
This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.
