Abstract
Objective
To study anatomical variations on MRI of the first extensor compartment of the wrist in DeQuervain tenosynovitis (DQT).
Materials and methods
A retrospective search for DQT patients yielded 47 subjects (51 ± 15 years, 36 female, 11 male). The age-matched control group (normal first extensor compartment) was 49 ± 15 years (29 female, 18 male). Two independent readers reviewed: the number of abductor pollicis longus (APL) tendon slips, tendon sheath septations (compartmentalization), and APL and EPB cross-sectional area (CSA) at the radial styloid. A tendon slip was defined as a discrete structure for ≥5 contiguous slices with its own insertion.
Results
The distribution of APL tendon slips was different for the DQT and control groups (Reader 1/Reader 2: P = 0.0001 and 0.001). The most common arrangement for both groups was two APL tendon slips. One tendon slip was less common (P = 0.03 and 0.1) and compartmentalization was more common (P = 0.003; < 0.0001) for the DQT group than the control group. There was no difference in tendon slip insertions on one or multiple bones (P = 0.1; 0.7). APL and EPB compartment CSAs were also higher for the DQT group (combined first extensor compartment area: 21.3 ± 7.6 mm2; 21.0 ± 7.1) than the control group (17.2 ± 3.8; 17.1 ± 3.9) (P = 0.002; 0.002).
Conclusion
We found a statistically significantly increased proportion of supernumerary tendon slips and compartmentalization of the first extensor compartment in patients with DQT and greater CSA of the first extensor compartment at the radial styloid, consistent with previous anatomical, surgical, and ultrasound studies.
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References
Keon-Cohen B. De Quervain’s disease. J Bone Joint Surg (Br). 1951;33–B:96–9.
Lacey T, Goldstein LA, Tobin CE. Anatomical and clinical study of the variations in the insertions of the abductor pollices longus tendon, associated with stenosing tendovaginitis. J Bone Joint Surg Am. 1951;33–A:347–50.
Fabrizio PA, Clemente FR. A variation in the organization of abductor pollicis longus. Clin Anat. 1996;9:371–5.
Motoura H, Shiozaki K, Kawasaki K. Anatomical variations in the tendon sheath of the first compartment. Anat Sci Int. 2010;85:145–51.
Roy AJ, Roy AN, De C, Banerji D, Das S, Chatterjee B, et al. A cadaveric study of the first dorsal compartment of the wrist and its content tendons: anatomical variations in the Indian population. J Hand Microsurg. 2012;4:55–9.
Tewari J, Mishra PR, Tripathy SK. Anatomical variation of abductor pollicis longus in Indian population: a cadaveric study. Indian J Orthop. 2015;49:549–53.
Shiraishi N, Matsumura G. Anatomical variations of the extensor pollicis brevis tendon and abductor pollicis longus tendon—relation to tenosynovectomy. Okajimas Folia Anat Jpn. 2005;82:25–9.
Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain’s disease. A study of operative findings. Int Orthop. 1995;19:209–11.
Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of De Quervain’s disease. Skeletal Radiol. 2009;38:1099–103.
Rousset P, Vuillemin-Bodaghi V, Laredo J-D, Parlier-Cuau C. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology. 2010;257:427–33.
Kwon BC, Choi S-J, Koh SH, Shin DJ, Baek GH. Sonographic identification of the intracompartmental septum in de Quervain’s disease. Clin Orthop. 2010;468:2129–34.
Nagaoka M, Matsuzaki H, Suzuki T. Ultrasonographic examination of de Quervain’s disease. J Orthop Sci. 2000;5:96–9.
Timins ME, O’Connell SE, Erickson SJ, Oneson SR. MR imaging of the wrist: normal findings that may simulate disease. Radiographics. 1996;16:987–95.
Sawaizumi T, Nanno M, Ito H. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31:265–8.
Okada M, Kutz JE. Excision of aberrant abductor pollicis longus tendon slips for decompression of de Quervain’s disease. J Hand Surg Eur Vol. 2011;36:379–82.
Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am. 1986;68:923–6.
McDermott JD, Ilyas AM, Nazarian LN, Leinberry CF. Ultrasound-guided injections for de Quervain’s tenosynovitis. Clin Orthop. 2012;470:1925–31.
Lutsky K, Kim N, Medina J, Maltenfort M, Beredjiklian PK. Hand dominance and common hand conditions. Orthopedics. 2016;39:e444–8.
Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg. 2007;41:36–8.
Leao L. De Quervain’s disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958;40–A:1063–70.
Choi S-J, Ahn JH, Lee Y-J, Ryu DS, Lee JH, Jung SM, et al. De Quervain disease: US identification of anatomic variations in the first extensor compartment with an emphasis on subcompartmentalization. Radiology. 2011;260:480–6.
De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med. 2009;28:779–86.
Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR imaging and US of the wrist tendons. Radiographics. 2016;36:1688–700.
Giles KW. Anatomical variations affecting the surgery of de Quervain’s disease. J Bone Joint Surg (Br). 1960;42–B:352–5.
Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg [Am]. 1990;15:83–7.
Belsole RJ. DeQuervain’s tenosynovitis diagnostic and operative complications. Orthopedics. 1981;4:899–903.
Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991;73:219–22.
Minamikawa Y, Peimer CA, Cox WL, Sherwin FS. De Quervain’s syndrome: surgical and anatomical studies of the fibroosseous canal. Orthopedics. 1991;14:545–9.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and was HIPAA-compliant.
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Chang, C.Y., Kheterpal, A.B., Vicentini, J.R.T. et al. Variations of anatomy on MRI of the first extensor compartment of the wrist and association with DeQuervain tenosynovitis. Skeletal Radiol 46, 1047–1056 (2017). https://doi.org/10.1007/s00256-017-2639-0
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DOI: https://doi.org/10.1007/s00256-017-2639-0