Does endoscopic release of the first extensor compartment have benefits over open release in de Quervain's disease?

Abstract

Superficial radial nerve injury, incomplete release of the first extensor compartment, palmar subluxation of the tendons and painful scar are the main reasons for persistent pain and dysfunction after open release. We therefore asked whether the endoscopic release of the first extensor compartment is advantageous over the open release in terms of subjective pain and disability, complication and aesthetic appearance.

METHODS: Fifty wrists treated with either open release (26 wrists) or endoscopic release (24 wrists) of the first extensor compartment in case of de Quervain's disease were included. All patients were evaluated at a minimum of 1-year follow-up using visual analogue scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score.

RESULTS: The average operating time of endoscopic release was 4 min longer than that of open release. The mean VAS pain score was improved from an initial 6.4 to 0.5 in the open release group and from 6.7 to 0.1 in the endoscopic release group. The mean DASH score was improved from 60.1 to 6.8 in the open release group and from 64.4 to 1.5 in the endoscopic release group. No clinically significant difference was found between the two groups regarding subjective VAS pain and DASH scores at the last follow-up. In the open release group, superficial radial nerve injuries (five wrists), significant scar tenderness (three) and unsightly scar (six) were identified.

CONCLUSIONS: Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain's disease who are unresponsive to non-operative treatments, despite a little increase in operation time.