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A Retrospective Review of Surgical Release of the First Dorsal Compartment in DeQuervain Tenosynovitis.
Brittany J. Behar, MD, Emma Dahmus, BS, Logan Carr, MD, John M. Ingraham, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.

BACKGROUND: DeQuervain’s tenosynovitis is often treated with intra-sheath corticosteroid injection. Failure of this method can sometimes be attributed to the presence of an extensor pollics brevis (EPB) subsheath. The objective of this study was to examine the demographics of patients who required surgical intervention for treatment of DeQuervain’s and determine any differences between those with an EPB subsheath and those without.
METHODS: A observational retrospective review was performed of patients who underwent surgical release of the first dorsal compartment at our institution by one of our current hand surgeons for treatment of DeQuervain’s Tenosynovitis. Data including age, handedness, gender, co-morbidities, previous hand injuries, any previous treatment for DeQuervain’s and any related imaging of the affected hand were collected.
RESULTS: One hundred and six patients met our inclusion criteria. The majority of patients were female (79%). Few patients were affected by thyroid disease (17%), were pregnant (1%), had diabetes (12%), autoimmune disorders (8%), or peripheral vascular disease (2%). A separate subsheath was identified in 51% of patients. DeQuervain’s affected both hands nearly equally and was usually present in the dominant hand (59%). Patients with an EPB subsheath presented early than those without (7.5 ± 8.8 months vs. 7.7 ±. 6.4 months, p=0.55). Most patients were provided with a splint for comfort (66%). Patients with and without an EPB subsheath received similar numbers of steroid injections prior to surgery (1.2 ± 0.5 versus 1.1 ± 0.3, p=0.11).Patients with an EPB subsheath present received surgical intervention at the same time (4.9 ± 5.9 months) as those with no EPB subsheath (4.9 ± 5.2 months). Similar rates of concomitant diagnosis were treated at the time of the first dorsal compartment release between the two groups. Almost all patients (93%) had complete relief of pre-operative symptoms on their first clinic follow up.
CONCLUSIONS: Our retrospective review characterized a typical DeQuervain patient. EPB subsheath presence was in keeping with previously reported literature rates. Patients with and without an EPB subsheath presented at equivalent times to a hand surgeon and waited similarly long before pursuing surgical intervention. This is different then previously reported literature has shown. Though these findings were not statistically significant, they are clinically relevant and additional patient recruitment may be needed.

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