Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 6 , ISSUE 2 ( July-December, 2024 ) > List of Articles

Original Article

Impact of the Relationship between Extensor Pollicis Brevis Entrapment Test and Ultrasound Wrist Findings and Functional Outcomes in De Quervain's Disease

Vijayaraja Elangovan, Lokesh K Sekaran, Harisudhan Raviraja, Dheepan Kumar, Ganesan G Ram

Keywords : De Quervain stenosing tenosynovitis, Muscular disease, Tendinitis, Tendon entrapment, Ultrasound

Citation Information : Elangovan V, Sekaran LK, Raviraja H, Kumar D, Ram GG. Impact of the Relationship between Extensor Pollicis Brevis Entrapment Test and Ultrasound Wrist Findings and Functional Outcomes in De Quervain's Disease. J Orth Joint Surg 2024; 6 (2):98-102.

DOI: 10.5005/jojs-10079-1148

License: CC BY-NC 4.0

Published Online: 14-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Diagnostic methods for first extensor compartment tenosynovitis are widely accepted, yet identifying variations in its anatomy and addressing compartmental challenges remains elusive. The extensor pollicis brevis (EPB) entrapment test has emerged as a valuable diagnostic tool. Integrating clinical assessment with ultrasound examination improves diagnostic efficacy, highlighting the importance of evaluating functional outcomes. Aim: To evaluate the connection between identified anatomical variations in patients with De Quervain's tenosynovitis and their functional outcomes and to ascertain how these variations are associated with the results of the EPB entrapment test and ultrasound wrist findings. Materials and methods: A total of 60 participants showed positive Finkelstein test results for wrist pain, underwent EPB entrapment, and underwent ultrasound examinations by a surgeon and radiologist. Surgery was the definitive benchmark. The preoperative assessment included disability of arm, shoulder, and hand (DASH) scores and visual analog scale (VAS) pain measurements at 6 weeks, with postoperative evaluations at both 6 weeks and 6 months. Results: Preoperatively (after 4 weeks), the QuickDASH score mean was 58.27%. Postoperative QuickDash score mean for 6 weeks and 6 months was 56.027 and 3.44%. The preoperative VAS score mean was 6.5. Postoperative VAS scores for 6 weeks and 6 months were 2.29 and 0.54. The p-value for DASH and VAS was highly significant, with a value of 0.0005. Conclusion: Our study emphasizes the significance of detecting anatomical variations in De Quervain's disease. Employing reliable diagnostic methods enhances surgical precision, improves patient recovery and recurrence prevention, and optimizes disease management.


HTML PDF Share
  1. Jackson WT, Viegas SF, Coon TM, et al. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am 1986;68(6):923–926. PMID: 3733780.
  2. Bonczar M, Walocha J, Pasternak A, et al. Anatomical variations in the first dorsal compartment of the wrist: meta-analysis. Folia Morphol (Warsz) 2023;82(4):766–776. DOI: 10.5603/FM.a2022.0081
  3. Giles KW. Anatomical variations affecting the surgery of de Quervain's disease. J Bone Joint Surg Br 1960;42-B:352–355. DOI: 10.1302/0301-620X.42B2.352
  4. Alexander RD, Catalano LW, Barron OA, et al. The extensor pollicis brevis entrapment test in the treatment of de Quervain's disease. J Hand Surg Am 2002;27(5):813–816. DOI: 10.1053/jhsu.2002.35309
  5. Rowland P, Phelan N, Gardiner S, et al. The effectiveness of corticosteroid injection for De Quervain's stenosing tenosynovitis (DQST): a systematic review and meta-analysis. Open Orthop J 2015;9:437–444. DOI: 10.2174/1874325001509010437
  6. Elangovan V, Rajappa S, Jeganathan GK, et al. Correlation between EPB entrapment test and ultrasound wrist findings in patients with De Quervain\'s disease. J Orthop Joint Surg 2023;5(2):45–49. DOI: 10.5005/jojs-10079-1114
  7. Lalonde D, Eaton C, Amadio P, et al. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery. Instr Course Lect 2015;64:249–259. PMID: 25745911.
  8. Lee ZH, Stranix JT, Anzai L, et al. Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. J Plast Reconstr Aesthet Surg 2017;70(1):127–131. DOI: 10.1016/j.bjps.2016.08.020
  9. Nayak SR, Hussein M, Krishnamurthy A, et al. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J 2009;32(6):600–604. PMID: 20035638.
  10. Wu F, Rajpura A, Sandher D. Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease. J Hand Microsurg 2018;10(2):116–118. DOI: 10.1055/s-0038-1626690
  11. Eichhoff E. Zur pathogenese der tendovaginitis stenosans. Bruns Beit Klin Chir 1927;CXXXIX:746–755.
  12. Clarke MT, Lyall HA, Grant JW, et al. The histopathology of de Quervain's disease. J Hand Surg Br 1998;23(6):732–734. DOI: 10.1016/s0266-7681(98)80085-5
  13. Dos Remédios C, Chapnikoff D, Wavreille G, et al. The abductor pollicis longus: relation between innervation, muscle bellies and number of tendinous slips. Surg Radiol Anat 2005;27(3):243–248. DOI: 10.1007/s00276-004-0286-3
  14. Rousset P, Vuillemin-Bodaghi V, Laredo JD, et al. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology 2010;257(2):427–433. DOI: 10.1148/radiol.10092265
  15. Lee KH, Kang CN, Lee BG, et al. Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci 2014;19(1):49–54. DOI: 10.1007/s00776-013-0481-3
  16. Harvey FJ, Harvey PM, Horsley MW. De Quervain's disease: surgical or nonsurgical treatment. J Hand Surg Am 1990;15(1):83–87. DOI: 10.1016/s0363-5023(09)91110-8
  17. Kume K, Amano K, Yamada S, et al. In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. J Hand Surg Eur Vol 2012;37(6):523–527. DOI: 10.1177/1753193411427829
  18. Earp BE, Han CH, Floyd WE, et al. De Quervain tendinopathy: survivorship and prognostic indicators of recurrence following a single corticosteroid injection. J Hand Surg Am 2015;40(6):1161–1165. DOI: 10.1016/j.jhsa.2014.12.027
  19. Bhat AK, Vyas R, Acharya AM, et al. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023;107(1):105–114. DOI: 10.1007/s12306-022-00735-0
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.