Surgical Management of De Quervain Tenosynovitis

Abstract

Introduction: De Quervain tenosynovitis (De Quervain’s Disease, DQD) is a common affection, renowned by its false benignity, wich can compromise the function of the hand especially in manual workers and be a source of non attendance at work. Surgical treatment represents a radical solution and deserves a bigger place in the management of this pathology. The aim of this work was to study the epidemiological, clinical and therapeutic aspects of DQD with a literature review. Methods: This is a retrospective study of 50 surgically treated DQD cases in the department of plastic and hand surgery of University Hospital of Nabeul between 2011 and 2021. The clinical criteria studied were: sharp pain on palpation of the radial border of the wrist and at  the maneuvers of stretching the concerned muscles (The maneuver of Eichhoff, The maneuver of Finkelstein, The test of G. Brunelli, kapandji). The results were evaluated according to the Kapandji score. Results: It is a series of adults (average age= 45 years), manual workers, predominantly female (sex ratio= 0, 25). The dominant side is affected in 80% of cases. Pain is the most common reason for consultation. The average duration of symptoms before surgery was less than 12 months in 64% of cases. Clinical signs were assessed by the finkelstein test which was positive in all cases. All our patients were operated on after failure of medical treatment, 14% longitudinal and 86% transverse incision, a septum was found in 40 cases, and it was resected. The termination of the abductor pollicis longus was split in 20 cases. The post-operative complications were essentially aesthetic represented by 4 hypertrophic scars. Resumption of work was done within the post-operative month. The results were evaluated according to the Kapandji score which was ≥ 9 in 84% of the cases. The Finkelstein test was negative in all cases and palpation in relation to the abductor pollicis longus tendon at the radial styloid did not cause any more pain. All patients reported a marked improvement in their symptomatology and the majority of cases were satisfied with the aesthetic outcome. Conclusion: The De Quervain tenosynovitis reputed by its false benignity is a disabling pathology, source of absenteeism in manual workers. Surgery finds its indication, since it is the only method to permanently eliminate pain and quickly resume a normal professional and daily activity.