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Pasiphol K, Agthong S, Thamrongskulsiri N, Dokthien S, Huanmanop T, Tabtieng T, Chentanez V. Relationship to the superficial radial nerve and anatomic variations of the first extensor compartment in Thai population: a basis for successful de Quervain tenosynovitis treatment. Anat Cell Biol 2024; 57:246-255. [PMID: 38680099 PMCID: PMC11184434 DOI: 10.5115/acb.24.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 05/01/2024] Open
Abstract
Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.
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Affiliation(s)
- Krittameth Pasiphol
- Doctor of Medicine Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sithiporn Agthong
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sirikorn Dokthien
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanasil Huanmanop
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanat Tabtieng
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vilai Chentanez
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Matsuura Y, Yamazaki T, Suzuki T, Akasaka T, Ohtori S. Opposition Transfer Using the Extensor Indicis Muscle and the Extensor Pollicis Brevis Tendon. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:383-389. [PMID: 38817755 PMCID: PMC11133921 DOI: 10.1016/j.jhsg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/19/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose This study aimed to introduce a novel technique using the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Furthermore, the efficacy of this novel method and the traditional Camitz technique was compared. Methods Patients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7 and 9 surgeries) or the Camitz technique (n = 8 and 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score were assessed. The repeated measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. Results The novel technique was associated with a significant postoperative improvement in palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score. In particular, the thumb-ring finger opposition angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. Conclusion The novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings. Type of study/level of evidence Therapeutic 4; Surgical technique.
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Affiliation(s)
- Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Takahiro Yamazaki
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyo Akasaka
- Department of Rehabilitation Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
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Thandoni A, Yetter WN, Regal SM. Anatomic location of the first dorsal extensor compartment for surgical De-Quervain's tenosynovitis release: A cadaveric study. World J Orthop 2024; 15:379-385. [PMID: 38709896 PMCID: PMC11045463 DOI: 10.5312/wjo.v15.i4.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/07/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND De-Quervain's tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist. Patients who fail conservative treatment modalities are candidates for surgical release. However, risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection. Currently, there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy. Thus, this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications. AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions. METHODS Six cadaveric forearms, including four left and two right forearm specimens were dissected. Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon. Distance of the first dorsal compartment from landmarks such as Lister's tubercle, the wrist crease, and the radial styloid were calculated. Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment, additional compartment sub-sheaths, number of abductor pollicis longus (APL) tendon slips, and the presence of a pseudo-retinaculum. RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm ± 0.80 mm. The distance from Lister's tubercle to the distal aspect of the extensor retinaculum was 13.37 mm ± 2.94 mm. Lister's tubercle to the start of the first dorsal compartment was 18.43 mm ± 2.01 mm. The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm ± 0.99 mm. The retinaculum length longitudinally on average was 26.82 mm ± 3.34 mm. Four cadaveric forearms had separate extensor pollicis brevis compartments. The average number of APL tendon slips was three. A pseudo-retinaculum was present in four cadavers. Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally (7.03 mm and 13.36 mm). CONCLUSION An incision that measures 3 mm proximal from the radial styloid, 2 cm radial from Lister's tubercle, and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.
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Affiliation(s)
- Aditya Thandoni
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - William Nicholas Yetter
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Steven Michael Regal
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15212, United States
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Kotzias D, Koutserimpas C, Chrysikos D, Bekos F, Georgakopoulos P, Tsakotos G, Salmas M, Piagkou M, Troupis T. Clinical Considerations of First Extensor Wrist Compartment (FEWC) Variants and De Quervain's Disease: A Review Study. Cureus 2023; 15:e42124. [PMID: 37602034 PMCID: PMC10437001 DOI: 10.7759/cureus.42124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
The first extensor wrist compartment (FEWC) displays significant variants. This review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain's tenosynovitis. A thorough search of PubMed and MEDLINE databases, following the PRISMA guidelines, was conducted from 2002 to 2022 to evaluate all FEWC variants, including the following: 1) the presence of an inter-tendinous septum, 2) the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3) their distal insertions and 4) the presence of a bony ridge within the FEWC. A total of 3878 wrists (1277 cadaveric and 1296 de Quervain patients) were included. Of the 1234 cadavers, a total of 701 (56.8%) were males and 533 (43.2%) were females. Regarding the 883 patients, 178 (20.2%) of them were males and 705 (79.8%) were females. An inter-tendinous septum was identified in 42.9% (47% of the patients' wrists compared to 39.3% of the cadaveric wrists, p<0.0001). Cadaveric wrists presented two or more slips for the APL in a significantly higher percentage (92.5%, p < 0.0001) compared to de Quervain patients' wrists (74.5%). Regarding the EPB muscle, de Quervain patients' wrists had a single slip in 93% (p=0.0007) and two or more slips in 3.6%, compared to cadaveric wrists (a single slip in 87%, and two or more slips in 11%, p< 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients' wrists (p < 0.0001). Remarkable diversity concerning the structures within the FEWC was reported. The presence of an inter-tendinous septum dividing the FEWC and a single EPB muscle slip is more likely to be found in patients with de Quervain's disease.
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Affiliation(s)
- Dimitrios Kotzias
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | | | - Filippos Bekos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | | - George Tsakotos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Marios Salmas
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Theodore Troupis
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
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Sugiura S, Matsuura Y, Suzuki T, Nishikawa S, Kuniyoshi K, Ohtori S. Histological assessment of a septum in the first dorsal compartment: a fresh cadaver study. J Hand Surg Eur Vol 2019; 44:805-809. [PMID: 30917737 DOI: 10.1177/1753193419838204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment; little is known about the histological features of such a septum. This study aimed to examine the intertendinous septum histologically and note its variations. After dissecting the first extensor compartment of 24 hands from 12 fresh frozen cadavers, the presence of any intertendinous septa was determined. The length of the extensor retinaculum and intertendinous septum was measured; histological findings of the first compartment with or without septa were studied and compared with those of the third/fourth compartment. Intertendinous septa were observed in 12 of 24 wrists. Histological assessment of the intertendinous septum revealed tissue similar in composition to the retinaculum observed between the third and fourth compartments.
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Affiliation(s)
- Shiro Sugiura
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.,Nishikawa Orthopaedic Clinic, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Chiba University, Chiba, Japan
| | | | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Ultrasonography could be used to predict extended insertion of the EPB tendon noninvasively. Surg Radiol Anat 2018; 40:995-999. [PMID: 29948040 DOI: 10.1007/s00276-018-2049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION An abnormal distal insertion of the extensor pollicis brevis (EPB) tendon into the thumb interphalangeal joint (IP) has been observed in refractory cases of de Quervain's disease. This is associated with the extensor being wider at the midpoint of the proximal phalanx; however, there is no method to noninvasively measure this. This study evaluated the accuracy of measuring the extensor width using ultrasonography, to establish a noninvasive method for predicting an EPB extending the IP insertion. MATERIALS AND METHODS Of 23 arms from 12 fresh frozen cadavers, the extensor tendon width at the midpoint of the proximal phalanx was measured using ultrasonography and directly at dissection. The association between these values was evaluated using correlation analysis. A cut-off value of extensor tendon width was obtained using receiver operating characteristic analysis. RESULTS A strong correlation was observed between the ultrasonography and the measured values. The EPB tendons were normal in 13 arms (57%) and extended in 10 (43%), with a significant difference between these groups in the mean width of the extensor tendon (6.8 ± 1.1 vs. 8.4 ± 1.0 mm). A cut-off extensor tendon width of 8.0 mm yielded an EPB extending the IP. CONCLUSION An EPB extending the IP tendon can be predicted by measuring the extensor tendon width at the midpoint of the proximal phalanx using ultrasonography. The cut-off tendon width value of ≥ 8.0 mm may be useful for assessments prior to surgery and for conservative care.
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