Symptomatic volar tendon subluxation after de Quervain's release is a complication of this common outpatient procedure. We present excision of the radial ridge as an alternative treatment to relieve pain associated with volar tendon subluxation following de Quervain's release.
Materials & Methods:
Six patients complained of painful volar subluxation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB), following the removal of a postoperative splint 2 to 4 weeks after the first dorsal compartment release for de Quervain's stenosing tenosynovitis. Patients underwent Provocative Testing by resisting extension of their thumb under their flexed index finger, then actively ranging their wrist through flexion and extension. Recreation of pain and palpable subluxation of the tendons was reliably reproduced in all patients with provocative testing. Two patients also complained of symptoms consistent with radial sensory branch neuritis and had a positive Tinel's sign on exam. During their initial procedure, all patients had undergone a first dorsal compartment release, as proposed by Burton, through either a longitudinal or transverse incision based just proximal to the radial styloid. During the second procedure, the same incision was opened sharply. Subcutaneous dissection was carried out bluntly. With direct view of the tendons of the first dorsal compartment, the wrist was ranged through extension and flexion. Volar subluxation of APL and EPB over a prominent fibro-osseous radial ridge at the most radial aspect of the first dorsal compartment was confirmed. The tendons were then retracted dorsally from the ridge. A volar-based periosteal flap was elevated from the radial ridge. The bony portion of the radial ridge was excised with a rongeur and filed smooth with a rasp. It was then sutured into place. The APL and EPB tendons were released from dorsal retractors. The tendons were noted to move fluidly from dorsal to volar and back - with wrist flexion and extension.
Patient follow-up showed no painful tendon subluxation or snapping. Repeat provocative testing revealed volar tendon translation with wrist flexion - without pain.
Following de Quervain's release, the APL and EPB tendons may sublux volarly or dorsally over the bounds of the first dorsal compartment. Painful subluxation occurs when over a sharp, prominent fibro-osseous ridge. Excision of this ridge removes the traumatic irritant to APL and EPB tendons. Without repetitive insult, the tendons glide painlessly over the radial styloid.