The first extensor wrist compartment variants. Clinical considerations of the De Quervain’s disease

Abstract

Abstract Purpose The first extensor wrist compartment (FEWC) displays significant variants. The current review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain’s tenosynovitis.Methods A meticulous online search in PubMed and MEDLINE databases was conducted to evaluate all FEWC variants, including: 1. the presence of an intertendinous septum (ITS), 2. the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3. their distal insertions and 4. the presence of a bony ridge within the FEWC.Results A total of 3878 (1277 cadaveric and 1296 de Quervain patients’) wrists were included. An ITS was identified in 42.9% wrists (47% of the patients’ compared to 39.3% of the cadavers’, p < 0.0001). Cadaveric wrists presented 2 or more APL tendinous slips in a significant higher percentage (92.5%) compared to de Quervain patients’ wrists (74.5%, p < 0.0001). Regarding EPB, de Quervain patients’ wrists had a single slip in 93% and 2 or more slips in 3.6%, compared to cadaveric wrists that the 87% had a single slip (p = 0.0007) and 2 or more slips in 11% (p < 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients’ wrists (p < 0.0001).Conclusions Remarkable diversity concerning the structures within the FEWC is reported. The presence of an ITS dividing the FEWC and a single EPB slip are more likely to be found in patients with de Quervain’s disease.