ڈی Quervain کی Tenosynovitis

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

Anatomy¶

• Anatomical variations in the first extensor compartment are clinically relevant to the pathophysiology and treatment of De Quervain's tenosynovitis [1].

Non-Operative Management¶

• Corticosteroid injection is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis [2].
• Corticosteroid injection with a short duration of immobilization is the primary and effective treatment for de Quervain tenosynovitis [14].
• The success rate for treating De Quervain's tenosynovitis decreases with multiple injections [25].
• Repeat injections for De Quervain's tenosynovitis have a high rate of success and are a viable clinical option [25].
• Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [8].

Operative Management¶

• Surgical release of De Quervain's tenosynovitis remains the gold standard treatment [6].
• Longitudinal incision for surgical release offers the advantage of easy identification of the compartment [6].
• Longitudinal incision for surgical release offers the advantage of more complete releases of tendon sheath and peritendinous adhesions [6].
• Longitudinal incision for surgical release offers the advantage of less risk of palmar subluxation of tendons [6].
• Release of the first extensor compartment for refractory de Quervain's disease results in good clinical outcomes with minimal morbidity [12].
• Endoscopic release of the extensor compartment is an effective and safe procedure for patients with de Quervain's disease who are unresponsive to nonoperative treatments [28].
• Endoscopic release of the extensor compartment is associated with a slight increase in operation time compared to open release [28].
• Endoscopic release for de Quervain's tenosynovitis provides earlier improvement after surgery compared with open release [30].
• Endoscopic release for de Quervain's tenosynovitis is associated with fewer superficial radial nerve complications compared with open release [30].
• Endoscopic release for de Quervain's tenosynovitis is associated with greater scar satisfaction compared with open release [30].
• Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis [4].
• Pulley reconstruction for de Quervain tenosynovitis provides satisfactory medium-term results [4].

Patient Factors and Outcomes¶

• Patients who scored lower than 40 for physical function had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
• Patients who scored higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
• Addressing misconceptions about the consequences of de Quervain's tenosynovitis and symptom duration allows patients to make informed decisions about treatment [5].

Anatomy & Pathophysiology¶

Anatomical Variations¶

• The EPB tendon is the most dorsal tendon in the first dorsal compartment and can be identified by its distally oriented muscle fibers [15].
• The APL tendon has no muscular fibers in the area of the first dorsal compartment [15].
• Separate compartments for the EPB and APL tendons are occasionally found, requiring identification of a septum [15].
• If the EPB tendon is absent, the floor of the compartment may show a Y-shaped tendinous insertion of the brachioradialis tendon [15].
• The superficial branch of the radial nerve is expected to be encountered in more than 50% of patients undergoing surgery for De Quervain's tenosynovitis [58].
• The radial artery courses dorsally just beyond the radial styloid, requiring caution during septum resection [15].

Pathological Mechanisms¶

• De Quervain's syndrome is defined as inflammation of the APL and EPB tendons in the first dorsal compartment caused by friction within a tight osteoligamentous tunnel [3].
• Friction between the APL and EPB tendons leads to compromised blood flow and nutrition, resulting in adhesion development and tendon stenosis [3].
• De Quervain's syndrome may involve myxoid degeneration, a process where connective tissues are replaced by a gelatinous or mucoid substance [3].
• De Quervain's syndrome is associated with trauma, extensor carpi ulnaris involvement, ligament instability, and repetitive strain [3].
• Tenovaginitis in the first extensor compartment is characterized by thickening of the fibrous sheath [11].
• De Quervain's disease results from anatomical factors associated with mechanical stressors [43].
• Women are more affected by De Quervain's disease than men due to manual work influencing first compartment dynamics [43].
• Training intensity is a major factor in determining De Quervain's disease in volleyball players [43].
• Wrist position influences the excursion of the extensor pollicis brevis tendon [44].
• Stenosing tenosynovitis causes a significant decrease in maximum velocity during slow fist tasks [48].

Classification¶

Anatomical Variations and Pathophysiology¶

• De Quervain's syndrome is defined as a condition originating when the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment become inflamed through friction within a tight osteoligamentous tunnel [3].
• The condition is characterized by compromised blood flow and nutrition, leading to adhesions and tendon stenosis [3].
• De Quervain's syndrome may represent a myxoid degeneration, defined as a degenerative process where connective tissues are replaced by a gelatinous or mucoid substance [3].
• Terminology for the condition varies, including tendinosis (degeneration without inflammation), tendinopathy (injury to the tendon), and tenosynovitis (inflammation or thickening of the fibrous sheath wall) [3].
• De Quervain's syndrome may not be an isolated pathology and has been associated with trauma, extensor carpi ulnaris involvement, ligament instability, and repetitive strain [3].
• The prevalence of a septated first dorsal compartment is considerably higher in patients with De Quervain tenosynovitis than previously reported [42].
• An intracompartmental septum between the APL and EPB tendons is present in a mean of 43% of wrists in cadaveric studies, with a range of 20% to 75% [17].
• The presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection [17].
• In a prospective study, 22 of 30 wrists (73%) that failed nonsurgical treatment and underwent operative release were found to have a separate compartment for the extensor pollicis brevis [32].
• The prevalence of a separate extensor pollicis brevis compartment in patients failing nonsurgical treatment is significantly higher than in the general population [32].
• In cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [18].
• Radial styloid abnormalities do not affect the outcome of management for de Quervain's disease [10].

Epidemiology and Risk Factors¶

• The unadjusted incidence rate of de Quervain's tenosynovitis in a young, active population was 0.94 per 1000 person-years [31].
• The unadjusted incidence rate for female patients was 2.81 per 1000 person-years, compared with 0.62 per 1000 person-years for male patients [31].
• The adjusted incidence rate ratio for females, with males as the referent category, was 4.45 (95% CI 4.28, 4.62) [31].
• The highest incidence rate was observed in the ≥40-year-old group at 1.37 per 1000 person-years [31].
• The adjusted incidence rate ratio for the ≥40-year-old group, compared to the <20-year-old group, was 3.65 (95% CI 3.26, 4.09) [31].
• Non-white race is a risk factor for de Quervain's tenosynovitis, with an adjusted incidence rate ratio of 1.31 (95% CI 1.21, 1.42) for black race and 1.17 (95% CI 1.05, 1.25) for other races compared to white race [31].
• De Quervain's syndrome affects approximately 1.3% of women and 0.5% of men in a population of adults of working age [17].

Diagnostic and Clinical Considerations¶

• Routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data [7].
• Addressing misconceptions about the consequences of de Quervain's tenosynovitis and symptom duration allows patients to make informed treatment decisions [5].
• Patients with a physical function score lower than 40 or a pain interference score higher than 60 on PROMIS measures had significantly increased odds of undergoing surgical release [23].

Clinical Presentation¶

Anatomy and Pathophysiology¶

• De Quervain's syndrome is defined as a condition where the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment become inflamed through friction, leading to pain [3].
• In De Quervain's syndrome, blood flow and nutrition become compromised, causing adhesions that lead to tendon stenosis [3].
• The condition is referred to by various terminologies including tendinosis, tendinopathy, and tenovaginitis/tenosynovitis [3].
• Fritz de Quervain described pain over the first dorsal compartment as a tenosynovitis following repetitive activity in 1895 [3].
• Theodor Kocher described de Quervain's as a "fibrous tendovaginitis" around the same time, noting that his patients lacked a history of repetitive strain [3].
• The pain in de Quervain's disease is attributed to friction of the EPL and APB against the pulley of zone 7 of the first extensor compartment [35].
• This friction results in initial tendinopathy followed by reactive thickening of the pulley [35].
• A septum can be present between the EPB and APL tendons within the first dorsal compartment [35].
• The EPB tendon is very small in bulk, while the APL has a variable number of tendons in its final portion at insertion [35].
• De Quervain's syndrome may not be an isolated pathology and may be associated with trauma, extensor carpi ulnaris involvement, ligament instability, or repetitive strain [3].

Clinical Symptoms and Signs¶

• Patients with de Quervain's tenosynovitis mostly complain of soreness and tenderness on the radial side of the distal radius [35].
• Symptoms are exacerbated by ulnar deviation of the thumb [35].
• Symptoms are exacerbated by a strong grasp combined with flexion and radial deviation of the wrist [35].
• Symptoms are exacerbated by firm pinching together of the index finger and thumb [35].
• Physical examination reveals tenderness and swelling directly over the first dorsal compartment [35].
• Palpation findings include feeling for moving nodularity, tendon rub, or popping directly over the tendon [38].

Diagnostic Testing¶

• Finkelstein's test is described as the standard test to confirm the diagnosis of de Quervain's tenovaginitis [35].
• The WHAT test (wrist hyperflexion and abduction of the thumb) is a more specific and sensitive test to diagnose de Quervain tenosynovitis than Eichhoff’s Test [35].
• Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease [38].
• The clinical diagnosis of de Quervain's tenosynovitis involves pain and tenderness over the radial styloid and either pain at the radial styloid reproduced by resisted thumb extension or a positive Finkelstein's test result [26].
• Using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease may be invalid [39].

Imaging¶

• Plain radiographic findings do not routinely predict the need for surgery or alter treatment courses in the initial diagnosis of De Quervain's tenosynovitis [37].
• In a study of 200 patients, 69.1% had at least one positive radiographic finding, with carpometacartic joint arthritis being the most common finding seen in 30.9% of cases [37].
• No radiographic findings altered the course of treatment in patients with isolated De Quervain's tenosynovitis [37].

Patient Factors and Perception¶

• More negative perceptions of the consequences of de Quervain's tenosynovitis are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [21].
• Worse pain catastrophizing is associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis [21].

Investigations¶

Imaging¶

• Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment [40].
• Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease [41].
• Styloid abnormalities do not affect the outcome of management for de Quervain's disease [10].

Anatomical Variations¶

• Anatomic variations in the first extensor compartment are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis [1].
• The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [20].
• When the extensor pollicis brevis tendon is associated with thumb interphalangeal joint extension, it is likely to reside in a subcompartment of the first dorsal compartment, particularly in patients with de Quervain's disease [46].

Treatment¶

Non-Operative¶

• Injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is the preferred initial treatment [2].
• One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners lead to short-term improvement in participants with de Quervain's tenosynovitis compared to placebo [19].
• Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [13].
• Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease [29].
• Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option [25].
• Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [27].
• The effectiveness of each additional corticosteroid injection does not appear to diminish in patients with diabetes mellitus [27].
• The presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome [17].
• Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [8].
• Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values [5].
• The practice of obtaining routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data [7].

Operative¶

• Longitudinal incision offers the advantage of easy identification of the compartment, more complete releases of tendon sheath and peritendinous adhesions, and less risk of palmar subluxation of tendons [6].
• The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity [12].
• Endoscopic release of the extensor compartment is an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments [28].
• Endoscopic release of the first extensor compartment is associated with a slight increase in operation time compared to open release [28].
• Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis and gives satisfactory medium-term results [4].
• Anatomic variations are frequently encountered in recalcitrant cases of de Quervain tenosynovitis [50].
• Examples of anatomic variations encountered in recalcitrant cases include multiple slips of the abductor pollicis longus and the extensor pollicis brevis in its own separate compartment [50].
• Outcomes for surgical treatment of de Quervain tenosynovitis are generally excellent [50].
• Complications of surgical treatment for de Quervain tenosynovitis include iatrogenic injury to the superficial branch of the radial nerve, tendon subluxation, complex regional pain syndrome, and recurrence due to incomplete release [50].
• The dorsal retinaculum is released during surgical treatment to prevent volar tendon subluxation [50].
• Surgical decompression should be considered if corticosteroid injection fails [17].
• The volarly based retinacular flap must remain over the released tendons to prevent volar tendon subluxation during surgical release [15].
• The first dorsal compartment is opened on its dorsoulnar side during surgical release [15].
• If the abductor pollicis longus and extensor pollicis brevis tendons cannot be easily retracted from the radial styloid, the surgeon should look for additional “aberrant” tendons and separate compartments [15].
• Releasing the extensor pollicis brevis tendon first and then the abductor pollicis longus usually reveals the presence or absence of a septum [15].
• If there is no extensor pollicis brevis present, the surgeon should inspect the floor of the compartment for the footprint of the brachioradialis tendon [15].
• The brachioradialis tendon has a Y-shaped tendinous insertion, and if this is clearly seen, release of this compartment is assured [15].
• Resection of a pronounced septum is warranted during surgical release, ensuring not to injure the underlying radial artery coursing dorsally just beyond the radial styloid [15].

Complications¶

Anatomical Variations and Surgical Risks¶

• The longitudinal incision technique creates a longer area in which skin scar may make cutaneous nerves more subject to scar adherence [15].
• The radial artery courses dorsally just beyond the radial styloid and must be avoided during septum resection [15].
• The volarly based retinacular flap must remain over the released tendons to prevent volar tendon subluxation [15].
• A longitudinal incision offers a less risk of palmar subluxation of tendons compared to other approaches [6].

Diagnostic and Anatomical Complications¶

• Finkelstein's test is a descriptive error that can produce a false positive [9].
• Extensor pollicis longus tenosynovitis can mimic de Quervain's disease because of its course through the first extensor compartment [9].
• The prevalence of a separate compartment for the extensor pollicis brevis is significantly higher in patients with unsatisfactory non-operative outcomes than in the general population [32].
• An intracompartmental septum is present in a mean 43% of wrists in cadaveric studies, with a range of 20 to 75% across different series [17].

Treatment-Related Complications and Outcomes¶

• Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis compared to nondiabetic patients [27].

Recovery¶

Non-Operative¶

• Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [14].
• According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment [2].
• Corticosteroid injections lead to treatment success 73.4% of the time within 2 injections [13].
• Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year [33].

Operative¶

• Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release [30].
• Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis, as the technique gives satisfactory medium-term results [4].

Patient Factors and Prognosis¶

• Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
• More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [21].

Key Evidence¶

• [L4] These variations are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis. [1] (10.1016/j.bjps.2016.08.020)
• [L4] According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment. [2] (10.1016/j.jhsa.2008.12.030)
• [L4] [3] (10.1177/1758998315599796)
• [L4] The authors believe the technique gives satisfactory medium-term results and should be considered part of the surgical treatment for de Quervain tenosynovitis. [4] (10.1055/s-0035-1556862)
• [L3] Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. [5] (10.1097/corr.0000000000001577)
• [L4] Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons. [6] (10.1007/s12306-018-0585-1)
• [L3] The practice of obtaining routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data. [7] (10.1055/s-0037-1606124)
• [L4] Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. [8] (10.1016/j.jhsg.2024.01.009)
• [L4] [9] (10.1016/j.jhsa.2014.09.024)
• [L4] Though considered as a manifestation of de Quervain's disease by some authors, styloid abnormalities do not affect the outcome of management as proved in this study. [10] (10.1007/s11552-010-9258-8)
• [L4] [11] (10.1054/jhsb.1999.0277)
• [L4] The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity. [12] (10.4055/cios.2014.6.4.405)
• [L3] This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. [13] (10.1177/1558944716681976)
• [L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. [14] (10.1016/j.jhsa.2024.03.003)
• [L3] [17] (10.1177/1753193415611414)
• [L4] In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised. [18] (10.2106/00004623-194931040-00019)
• [L1] One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. [19] (10.1186/1471-2474-10-131)
• [L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. [20] (10.1177/17531934231214137)
• [L3] More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. [21] (10.1097/corr.0000000000000992)
• [L4] Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis. [23] (10.1016/j.jhsa.2023.07.005)
• [L2] Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option. [25] (10.1016/j.jhsa.2021.04.018)
• [L1] [26] (10.1002/14651858.cd005616.pub2)
• [L4] Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish. [27] (10.1016/j.jhsa.2022.02.018)
• [L4] Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments, despite a little increase in operation time. [28] (10.1016/j.bjps.2011.05.015)
• [L1] Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease. [29] (10.1016/j.otsr.2019.11.015)
• [L1] Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. [30] (10.1302/0301-620x.95b7.31486)
• [L2] [31] (10.1016/j.jhsa.2008.08.020)
• [L4] Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year. [33] (10.1007/s12593-009-0018-3)
• [L2] [35] (10.1177/1753193412475043)
• [L4] [37] (10.1055/s-0040-1716522)
• [L3] [38] (10.1055/s-0038-1626690)
• [L3] This finding may question the validity of using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease. [39] (10.1197/j.jht.2008.03.004)
• [L5] Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment. [40] (10.1136/bcr-2021-242173)
• [L4] Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease. [41] (10.1007/s12593-009-0001-z)
• [L3] The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis. [42] (10.1177/1558944718810864)
• [L4] [43] (10.1177/0363546504268134)
• [L4] In vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. [44] (10.1016/j.jht.2017.12.004)
• [L4] When it does, particularly in patients with de Quervain's disease, it is likely to reside in a subcompartment of the first dorsal compartment. [46] (10.1016/j.jhsa.2008.12.015)
• [L3] Those subjects demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations that can occur in the setting of hand pathology. [48] (10.1177/1558944717729218)
• [L2] The anatomical findings are consistent with previous studies, with an expectation to encounter the superficial branch of the radial nerve in more than 50% of patients. [58] (10.1055/s-0039-1688700)

References¶

[1] Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017. DOI: 10.1016/j.bjps.2016.08.020

[2] Nonsurgical Treatment for de Quervain's Tenosynovitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.030

[3] De Quervain’s syndrome: It may not be an isolated pathology. Hand Therapy. 2015. DOI: 10.1177/1758998315599796

[4] Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results. Journal of Wrist Surgery. 2015. DOI: 10.1055/s-0035-1556862

[5] Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain’s Tenosynovitis?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001577

[6] Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients. MUSCULOSKELETAL SURGERY. 2019. DOI: 10.1007/s12306-018-0585-1

[7] Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients. Journal of Wrist Surgery. 2017. DOI: 10.1055/s-0037-1606124

[8] De Quervain’s Tenosynovitis: As Seen from the Perspective of the Patient. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.009

[9] Longitudinal Split Tear of the Extensor Pollicis Brevis Tendon: Report of 2 Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.09.024

[10] Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?. HAND. 2010. DOI: 10.1007/s11552-010-9258-8

[11] De Quervain’s Disease. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0277

[12] Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores. Clinics in Orthopedic Surgery. 2014. DOI: 10.4055/cios.2014.6.4.405

[13] Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis. HAND. 2016. DOI: 10.1177/1558944716681976

[14] Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.003

[15] Campbell S Operative Orthopaedics 4 Volume Set. EXCISION OF NECROTIC MUSCLES COMBINED WITH NEUROLYSIS OF MEDIAN AND ULNAR NERVES FOR SEVERE CONTRACTURE > SURGICAL TREATMENT OF DE QUERVAIN DISEASE.

[17] Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415611414

[18] AN UNUSUAL FORM OF DE QUERVAINʼS SYNDROME. The Journal of Bone & Joint Surgery. 1949. DOI: 10.2106/00004623-194931040-00019

[19] Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-131

[20] Prediction of an intracompartmental septum and its effect on outcomes of endoscopic release for de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231214137

[21] Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain’s Tenosynovitis? A Cross-sectional Study. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000992

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