Surgical Treatment Outcome of de Quervain's Disease: A Systematic Review and Meta-analysis

Abstract

Background: Surgical release of the extensor retinaculum is performed as a treatment for de Quervain's (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic review and meta-analysis were conducted.

Methods: A systematic search was performed in Embase, Medline Ovid, Web of Science Core Collection, Cochrane, and Google Scholar. Articles regarding surgical treatment of DQ disease that reported outcome and complications were included. We extracted exact values of visual analog scale scores and percentages of patients who experienced pain at follow-up. Complications assessed were (sub) luxation, superficial radial nerve injuries, wound infections, and scar problems.

Results: Twenty-one studies with a total of 939 patients were included. Five percent of these patients (95% CI 1%-18%) did not show complete remission of pain at follow-up. When pooled, the mean reduction in visual analog scale scores was 5.7 (95% CI 5.3-6.1) on a 0-10 scale. No difference in outcome between different types of surgery or incisions was seen. Based on the meta-analysis, the pooled complication rate was 11% (95% CI 5%-22%).

Conclusions: Five percent of patients still have residual pain after surgical release of the first extensor compartment. Surgery type, as well as the type of incision, did not affect outcome or complication. Thus, surgical release of the extensor retinaculum for DQ disease is an effective treatment, regardless of the type of surgery.

Fig. 1.

Flow chart of study selection.

Fig. 2.

Depiction of the different types of skin incisions used to perform an open release. A–C, Transverse incision, longitudinal incision, and an oblique incision. Reprinted with permission from Esser Masterclass.

Fig. 3.

Residual pain at follow-up. This figure depicts the proportion and 95% CI of the patients who had pain at the follow-up measurement. Only articles that included pain as a complication are included. The black squares denote the proportion of patients that still had residual pain at follow-up. The lines represent the 95% CI. The black diamond displays the overall proportion and 95% CI.

Fig. 4.

VAS pain scores after open or endoscopic surgery. This figure depicts the mean and 95% CI decrease in VAS separate for open or endoscopic surgery. The lowest diamond depicts the overall mean decrease in VAS; the upper two diamonds depict the mean decrease in VAS after open or endoscopic release.

Fig. 5.

Forest plot for the complication rate and 95% CI for each type of skin incision. The lowest diamond depicts the overall complication rate; the three upper diamonds depict the complication rate for transverse, oblique, and longitudinal incisions. There is no significant difference between the complication rates.

Fig. 6.

One-portal endoscopic release. A 2-cm transverse incision is made just proximal to the carpometacarpal joint. Reprinted with permission from Esser Masterclass.

Fig. 7.

Two-portal endoscopic release. The two incisions for the portals are made 1.5 cm distal to the radial styloid process and the other 2.5 cm proximal to the radial styloid process. Reprinted with permission from Esser Masterclass.

Fig. 8.

Z-plasty. First, an oblique incision is made to release the first extensor compartment. Subsequently, the distal ulnar based flap and the proximal radial based flap are sutured together. Reprinted with permission from Esser Masterclass.

Fig. 9.

Pulley reconstruction of the first compartment. A transverse incision is made to release the first extensor compartment. The extensor retinaculum is harvested to obtain a graft of 0.8 cm by 2 cm. Before the anchors are inserted to fix the graft, the bone is predrilled with a 1.3-mm drill bit. Subsequently, the graft is first anchored on the volar side of the abductor pollicis longus and the extensor pollicis brevis. The second anchor is placed dorsally. Reprinted with permission from Esser Masterclass.