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Die Erweiterungsplastik des ersten Strecksehnenfachs zur operativen Behandlung der Tendovaginitis de Quervain

Enlargement plasty of the first dorsal compartment for the surgical treatment of de Quervain’s tenosynovitis

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Zusammenfassung

Operationsziel

Zuverlässige Schmerzreduktion, Beachtung anatomischer Varianten, Vermeidung von Komplikationen.

Indikationen

Versagen der konservativen Therapie, klinisch eindeutige Diagnose, positiver Provokationstest nach Finkelstein (pathognomonisch).

Kontraindikationen

Früher durchgeführte Spaltung des Retinakulums des 1. Strecksehnenfachs (SSF), fehlende Eindeutigkeit der Diagnose.

Operationstechnik

Hautinzision unter Schonung der Äste des Ramus superficialis nervi radialis, Darstellung des 1. SSF, w-förmige Eröffnung und Präparation der Retinakulumlappen. Darstellung aller Sehnen, Inspektion des Bodens des 1. SSF und anatomischer Varianten. Lockere Adaptation der Lappen, Spülung, Hämostase, Hautnaht.

Weiterbehandlung

Konsequente Ruhigstellung in der Daumengipsschiene für insgesamt 3 Wochen (+ 3 Wochen fakultativ abhängig von Belastung/Beruf). Nach 2 Wochen Entfernung des Nahtmaterials, nach 3 Wochen Beginn mit selbständigen Mobilisationsübungen des Handgelenks (aus der Schiene heraus).

Ergebnisse

Zwischen August 2005 und Juli 2007 wurden 38 Patienten (40 Handgelenke) ohne Komplikationen operiert. Keine (Sub-)Luxationen der Sehnen, einmal persistierend leicht positiver Finkelstein-Test, in allen anderen Fällen vollständige Beschwerdelinderung. Alle Patienten würden den Eingriff erneut durchführen lassen.

Abstract

Objective

Reliable reduction of pain, observance of anatomical variations, avoidance of complications.

Indications

Failure of conservative treatment, clinically obvious diagnosis, positive Finkelstein test (pathognomonic).

Contraindications

Previous splitting of the retinaculum of the first dorsal compartment, uncertainty of diagnosis.

Surgical technique

Skin incision with protection of the branches of the superficial radial nerve, exposure of the first dorsal compartment, w-shaped incision and preparation of the retinaculum lobes, exposure of all tendons, inspection of the whole compartment and possible anatomic variations. Loose adaptation of the lobes, irrigation, hemostasis, skin closing.

Postoperative management

Consequent immobilization in a thumb cast for a total of 3 weeks (+ 3 weeks optional depending on load/profession). Sutures removed after 2 weeks, then the patient can start mobilization exercises (without the splint) after 3 weeks.

Results

Between August 2005 and July 2007, 38 patients (40 wrists) were operated without complications. No tendon subluxation/dislocation, one wrist with persistent slightly positive Finkelstein test, in all other cases complete relief of the symptoms. All patients would elect to repeat the surgery.

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Abbreviations

SSF:

Strecksehnenfach

APL:

Abductor pollicis longus

EPB:

Extensor pollicis brevis

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. J. Bering, D. Bignion und P. Kurzen geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädische Klinik, Luzerner Kantonsspital, 6000, Luzern, Schweiz

    J. Bering

  2. Handchirurgie, Hohmad Privatklinik, Thun, Schweiz

    D. Bignion

  3. Die Handpraxis, Handchirurgie Oberaargau, Langenthal, Schweiz

    P. Kurzen

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  1. J. Bering
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  2. D. Bignion
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  3. P. Kurzen
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Correspondence to J. Bering.

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Bering, J., Bignion, D. & Kurzen, P. Die Erweiterungsplastik des ersten Strecksehnenfachs zur operativen Behandlung der Tendovaginitis de Quervain. Oper Orthop Traumatol 25, 361–371 (2013). https://doi.org/10.1007/s00064-012-0206-3

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  • DOI: https://doi.org/10.1007/s00064-012-0206-3

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