Tendoscopic versus open release for de Quervain’s disease: earlier recovery with 7.21 year follow-up

Purpose To compare the time return to work and long-term results of tendoscopic versus open technique for de Quervain’s disease. Methods From 2005 to 2013, either tendoscopic or open decompression was performed on 56 consecutive patients (56 wrists) with symptomatic de Quervain’s disease despite a minimum of 3 months non-operative treatment. Of the 50 patients who met the inclusion criteria, 41 patients were followed-up for a mean of 7.21 years postoperatively. Among these 41 wrists, 20 underwent tendoscopic release (group A), and 21 underwent open release (group B). The clinical evaluations were performed preoperatively, 1 month postoperatively and at last follow-up visit, using visual analog scale (VAS); the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome score; and the Finkelstein’s test. The Patient and Observer Scar Assessment Scale (POSAS) was used as an esthetic evaluation tool of the scar at last follow-up. Results No significant baseline differences were found between two groups. The average time return to work in group A was less than in group B (P < 0.05), The mean VAS and DASH scores improved significantly in both groups at 1 month and last follow-up visit (P < 0.001). At 1 month, the scores in group A were significantly better than in group B (P < 0.05 and P < 0.001, respectively). There was no difference between groups at last follow-up. In addition, the improvement of the mean DASH score was significantly greater in group A than in group B (34.74 ± 10.99 in group A and 23.58 ± 12.01 in group B, P < 0.01) at 1 month. For POSAS scale, both the OSAS and PSAS scores were significantly better in group A. One patient in group A had cephalic vein injury and 3 patients in group B was involved with radial sensory nerve injury. All patients showed negative on Finkelstein’s test at last follow-up. Conclusions The results of this study suggest that tendoscopic technique for de Quervain’s disease could provide earlier symptom relief and earlier recovery with fewer complications and more desirable scar, as well as equivalent successful long-term outcome, when compared with traditional open release technique.

Akupunktur sebagai Terapi De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a disease with pain and edema in the styloid process due to thickening of the sheathsthat encase the tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). Management of DeQuervain’s tenosynovitis include pharmacotherapy combined with conservative therapy and if it fails then surgicalintervention is required. In case of De Quervain’s tenosynovitis, acupuncture for relieving pain and stiffness. Reportedthe case of a woman aged 52 year, complaints of pain and stiffness in the left thumb since two months before went tothe Poliklinik Akupunktur dr. Cipto Mangunkusumo Nasional Hospital. On physical examination the left wrist areafound tenderness and spasm in the area of APL and EPB, VAS 4, there was limitation in the first carpometacarpal jointfunctional and Finkelstein’s test was positive. Acupuncture therapy done at the point LI5, LU7, LU9 and Ashi. Therewas pain reduction and functional improvement of the carpometacarpal joints. Acupuncture gives good results forpain and stiffness in patients with de Quervain’s.

Intra sheath corticosteroid injection for De Quervain’s tenosynovitis

<p class="abstract"><strong>Background:</strong> De Quervain’s disease or stenosing tenosynovitis of the first dorsal compartment of the wrist is a common condition, which affects the Abductor pollicis longus and the extensor pollicis brevis tendons. There are characteristic signs and symptoms including a positive Finkelstein's test. Different options for treatment include conservative approaches like analgesics, splinting and physical therapy. If conservative options fail then steroid injection is considered.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of single dose intra-sheath triamcinolone and lignocaine injection in 32 patients at our institute who were followed up for a period of 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study there were 25 females and 7 males with a mean age of 46.4±8.03 years. Right side was involved in 17 patients and left side in 15 patients. The pre procedure VAS score was 8.65±1.07. The follow up VAS scores at 1, 6 and 12 months respectively were 1.4±1.14, 0.84±1.06 and 1.03±1.26 respectively. 4 out of 32 patients had positive Finkelstein’s test at 1 year follow up. Common complications were pain at injection site, which was seen in 5/32 patients and depigmentation seen in 2/32 patients.</p><p class="abstract"><strong>Conclusions:</strong> Thus intra sheath triamcinolone injection is a safe and effective procedure for treatment of De Quervains disease.</p>

Finkelstein's Test Is Superior to Eichhoff's Test in the Investigation of de Quervain's Disease

Introduction de Quervain's tenosynovitis is a common pathologic condition of the hand. Finkelstein's test has long been considered to be a pathognomonic sign of this diagnosis, yet most clinicians and instruction manuals erroneously describe what is in fact the Eichhoff's test, which is thought to produce similar pain by tendon stretching in a normal wrist. The purpose of this study was to compare Finkelstein's test with Eichhoff's test in asymptomatic individuals. Materials and Methods Thirty-six asymptomatic participants (72 wrists) were examined using both Finkelstein's and Eichhoff's tests with a minimum interval of 24 hours between the tests. Results The results showed that Finkelstein's test was more accurate than Eichhoff's test. It demonstrated higher specificity, produced significantly fewer numbers of false-positive results, and also caused significantly less discomfort to patients. Conclusion This study recommends Finkelstein's test as the clinical examination of choice for the diagnosis of de Quervain's disease.

Finkelstein’s Test: A Descriptive Error that Can Produce a False Positive

Over the last three decades an error in performing Finkelstein’s test has crept into the English literature in both text books and journals. This error can produce a false-positive, and if relied upon, a wrong diagnosis can be made, leading to inappropriate surgery.