Analysis of Functional outcome of surgical release for Dequervain’s disease

Sivakumar, M (2015) Analysis of Functional outcome of surgical release for Dequervain’s disease. Masters thesis, Madurai Medical College, Madurai.

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Abstract

BACKGROUND: Several operative methods have been described for de Quervain’s disease, but nodefinite consensus has emerged in the literature. Sometimes simple release of the extensorretinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of theextensor retinaculum can cause volar subluxation of the abductor pollicislongus and extensorpollicisbrevis tendons. In this prospective study, we evaluated the early results of operativetreatment with release of tendon sheath of abductor pollicislongus and extensor pollicisbrevis along with partial resection of the extensor retinaculum when conservative methods have failed. With Positive Finkelstin’s test and Ultrasonographical thickening. HYPOTHESIS: We hypothesized that partial removal of the extensor retinaculum may be used asan alternative to solve problems such as incomplete release or re-adhesion and volar subluxationof the tendons. . PATIENTS AND METHODS: Our study includes 20 resistant cases of de quervains disease. open surgical release of tendon sheath of abductor pollicislongus and extensor pollicisbrevis along with excision of thin strip of dorsally based extensor retinaculam. Mean age group in all operated cases 28- 45 years among 20 patients 19 were females 1 is male. Involvement of right wrist is 13 and left wrist is 7. Dominant extremity is commonly involved. Dequervains disease is caused by repetitive forearm wrist activities in our study group housewifes are 75% patients overall. Average time for conservative management is 6 months. Open surgical release of extensor tendon sheaths of extensor pollicisbrevis and abductor pollicislongus. The mean pre operative DASH score is 78.25 where as mean post operative DASH score is 8.03 which is statistically significant. The mean pre operative VAS score is 8.65 where aspost operative VAS score is 0.35 which is statistically significant. The successful treatment of dequervains disease is defined as more than a 25% reduction in disabilities of arm shoulder hand (DASH) and visual analog scale without a105reintervention after 1 year. Pain relief was achieved in all 20 patient. 2 cases had transient numbness of thumb . Release of abductor pollicislongus and extensor pollicisbrevis tendon sheath alongwith thin strip of dorsally based flap of retinaculam removal will improve the functional outcome. 1. DeQuervain's Disease, although frequently unrecognized, is a crippling condition which is easily remedied by surgery. 2.. The condition is far more prone to occur in women, and this pathologic condition should be considered in the differential diagnosis of persistent pain at the base of the thumb in the region of the radial styloid. 3. Surgery is the only treatment for this condition, and should be carried out as soon as possible. In our study group follow up is short term. Long term follow up is necessary before conclude the outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Dequervain’s disease ; Finkelstin’s test ; Abductor pollicislongus ; extensor pollicisbrevis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 02:16
Last Modified: 25 Sep 2017 02:20
URI: http://repository-tnmgrmu.ac.in/id/eprint/3315

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