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KMID : 0621520080130010015
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Journal of the Korean Society for Surgery of the Hand
2008 Volume.13 No. 1 p.15 ~ p.19
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The Incidence of Separate Septum and Variant of the Number of Slips of APL in de Quervain’s Disease and the Usefulness of the 1,2 ICSRA in Identification of the First Extensor Compartment
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Rhyou In-Hyeok
Chung Chae-Ik
Suh Bo-Gun
Kim Kyung-Chul
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Abstract
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Purpose: We evaluated the results of surgical treatment of de Quervain’s disease with the investigation of the incidence of the separate septum within first extensor compartment and the number of the slips of the APL. In addition, we want to report the usefulness of the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) in identification of the first extensor compartment.
Methods: In 17 patients unresponsive to non-operative treatment for at least 6 months we managed surgically. Under regional anesthesia 1st extensor compartment was released as radial-based flap through 2 cm transverse skin incision proximal to radial styloid process. Patients were assessed retrospectively at average 12.2 months for pain relief, postoperative Finkelstein test, symptom of superficial radial nerve and painful palmar subluxation. The degree of pain relief was evaluated with Visual Analog Scale from no pain 0 to severe pain 10. Separate septum and slips number of APL were examined intraoperatively and the usefulness of 1,2 ICSRA was investigated.
Results: Resting pain disappeared but 6 patients complained of slight negligible discomfort after strenuous exercise. Mean VAS is 0.7 (0~2). Postoperative Finkelstein test was negative in all patients. Superficial radial nerve symptom was found in one patient but disappeared within 4 weeks. The slips number of APL was more than 3 in 16 cases except one case of 2 slips. EPB was found in all cases; one case, two slips and the others one slip. Separate septum was identified in 9 cases (53%). 1,2 ICSRA was helpful to identify the first extensor compartment.
Conclusion: The high number of the APL slips and the separate septum may be one cause of failed conservative treatment. The surgical result of de Quervain’s disease was acceptable based on the high patient satisfaction and low complication rate. 1,2 ICSRA can be useful guide to identification of the ulnar margin of first extensor compartment.
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KEYWORD
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De Quervain, 1/2 ICSRA
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