Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2024; 15(4): 379-385
Published online Apr 18, 2024. doi: 10.5312/wjo.v15.i4.379
Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release: A cadaveric study
Aditya Thandoni, William Nicholas Yetter, Steven Michael Regal
Aditya Thandoni, William Nicholas Yetter, Steven Michael Regal, Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15212, United States
Author contributions: All authors contributed equally to this project; Thandoni A wrote the proposal, obtained funding for the cadavers and wrote the manuscript; Thandoni A and Yetter WN performed all data collection and analysis; Yetter WN and Regal SM made edits to the manuscript; Regal SM performed all cadaveric dissections, coordinated and designed the study; all authors approved the final version of the article.
Institutional review board statement: This study was a cadaveric investigation and did not involve human subjects; institutional review board approval was therefore not necessary for the research presented in this article. However, we will provide our institutional tissue approval protocol.
Institutional animal care and use committee statement: This study does not involve animal subjects.
Conflict-of-interest statement: The authors have no conflict of interests to disclose.
Data sharing statement: No additional data are available beyond what is presented in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aditya Thandoni, MD, Doctor, Researcher, Surgeon, Department of Orthopaedic Surgery, Allegheny Health Network, 320 E North Avenue, Pittsburgh, PA 15212, United States. adityathandoni@gmail.com
Received: November 28, 2023
Revised: February 7, 2027
Accepted: April 2, 2024
Published online: April 18, 2024
Processing time: 140 Days and 7 Hours
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.

Keywords: De-Quervain’s tenosynovitis; First extensor compartment; Cadaveric study; Superficial radial nerve; Radial styloid; Lister’s tubercle

Core Tip: Surgical release of the first extensor compartment at the level of the wrist has been well documented with multiple different techniques. Injury to the superficial radial nerve, decompressing the incorrect compartment, tendon injury, and incomplete release of the compartment leads to patient morbidity. We describe the precise anatomic location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions. We demonstrate the location of the superficial radial nerve and document the variances in the first compartment sub-sheaths. In doing so, we have created a surgical protocol that will ensure a complete first compartment release.