Intra operative Anatomical variations of the first extensor compartment of the wrist in patients of de Quervain’s disease


  • Israr Ahmad Associate Professor, Department of Orthopaedics Hayatabad Medical Complex Peshawar
  • Khadim Hussain Assistant Professor Department of Orthopaedics, Gomal Medical college Dera Ismail Khan
  • Zeeshan Khan Assistant Professor, Department of Orthopaedics Hayatabad Medical Complex Peshawar
  • Salik Kashif Assistant Professor, Department of Orthopaedics Hayatabad Medical Complex Peshawar
  • Mohammad Saeed Assistant Professor, Department of Orthopaedics Hayatabad Medical Complex Peshawar
  • Muhammad Arif Khan Professor, Department of Orthopaedics Hayatabad Medical Complex Peshawar


De Quervain’s disease, Tenosynovitis, Abductor Pollicis Longus, Extensor Pollicis Brevis, Fibro-osseous tunnel.


Objective: To determine the frequency of intra operative anatomical variations in patients undergoing surgical release for de Quervain’s disease.

Methods: We conducted this descriptive study in Department of Orthopaedics and spine surgery Khyber Girls Medical College/Hayatabad Medical Complex Peshawar from 21st January 2017 to 24th December 2019.All patients of de Quervain’s disease fulfilling the inclusion criteria were surgically released under local anaesthesia. The frequency of intra operative anatomical variations of Abductor Pollicis Longus(APL) and Extensor Pollicis Brevis(EPB) were noted and classified according to the Hiranuma classification.

Results: We enrolled 80 patients (86 wrists) in our study. The mean age was 41years(range 25 to 75 years).Female patients were 71(88.7%) and male patients were only 9(11.2%).Majority(88.7%,n=71) of patients had right sided de Quervain’s disease while left sided was involved in 3(3.7%) patients and 6(7.5%) patients had bilateral de Quervain’s disease. Hiranuma Type II was the predominant anatomical variation noted in 53(61.6%) wrists followed by type I(26.7%,n=23).Majority(91.8%,n=79) of wrists had 1 APL tendon followed by 2 APL tendons in 4(4.6%) and 3 tendons in 3(3.4%) wrists. The number of EPB was 1 in 82(95.3%) wrists,2 in 1(1.1%) and absent EPB in 03(3.4%) wrists.

Conclusion: Majority of our patients had APL and EPB in separate compartments with complete septation and had single APL and EPB tendon in each compartment. On the contrary the traditional or classical presentation of APL and EPB lying side by side in a single compartment was noted in less number of patients.


Kay NR. De Quervain's disease. Changing pathology or changing perception? J Hand Surg Br. 2000;25(1):65-9.

De Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds:1895. Am J Orthop.1997;26:641-644.

Finkelstein H. Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg Am.1930;12:509-540.

Keon-Cohen B: De Quervain's disease. J Bone Joint Surg Br.1951;33:96-99.

Clarke MT, Lyall HA, Grant JW, Matthewson MH: The histopathology of de Quervain's disease. J Hand Surg [Br].1998;23:732-734.

Lee ZH, Stranix JT, Anzai L, Sharma S. Surgical anatomy of the first extensorcompartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. J. Plast Reconstr Aesthet Surg.2017;70:127-31.

Hadianfard M, Ashraf A, Fakheri M, Nasiri A. Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis: A randomized controlled trial. J Acupunct Meridian Stud. 2014;7:115-21.

Moore JS: De Quervain's tenosynovitis: Stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med. 1997;39:990-1002.

Harvey FJ, Harvey PM, Horsley MW: De Quervain's disease: Surgical or nonsurgical treatment. J Hand Surg [Am]. 1990;15:83-87.

Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg [Am].1994;19:595-598.

Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007; 15:757-64.

Peck E. Successful treatment of de Quervain tenosynovitis with ultrasound?guided percutaneous needle tenotomy and platelet?rich plasma injection: A case presentation. Phys Med Rehab 2013;5:438-41.

Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra?sheath triamcinolone injection. Int Orthop. 2007;31:265-8.

Mirzanli C, Ozturk K, Esenyel CZ, Ayanoglu S, Imren Y, Aliustaoglu S. Accuracy of intrasheath injection techniques for de Quervain's disease: a cadaveric study. J Hand Surg Eur. 2012; 37: 155-60.

Minamikawa Y, Peimer CA, Cox WL, Sherwin FS. De Quervain’s syndrome: Surgical and anatomical studies of the fibro osseous canal. Orthopedics. 1991;14:545-549.

Thwin SS, Fazlin F, Than M. Multiple variations of the tendons of the anatomical snuffbox. Singapore Med J. 2014; 55: 37-40.

Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain's disease. Clin. Anat. 2000;13:195-8.

Leslie BM, Jr EW, Morehead JR. Incidence of a septum within the first dorsal compartment of the wrist. J. Hand Surg. 1990;15:88-91.

Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J. Bone Joint Surg. Am.1991;73:219-223.

Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg.2007;41:36-38.

Gilles KW. Anatomical variations affecting the surgery of de Quervain’s disease.J bone Joint Surg[Br].1960;42(2):352-355.

Gundes H, Tosun B. Longitudinal Incision in Surgical Release of De Quervain Disease. Techniques in Hand and Upper Extremity Surgery.2005;9(3):149-152.

Gao ZY, Tao H, Xu H, Xue JQ, Ou-Yang Y, Wu JX. A novel classification of the anatomical variations of the first extensor compartment. Medicine.2017;96:35-40.

Hiranuma A, Houjo H, Sakaguchi S. De Quervain’s tenosynovitis and anatomical variation of first extensor compartment. Orthop Surg. 1972;23:1186-1188.

Jackson WT, Viegas SF, Coon TM. Anatomical variations in the first extensor compartment of the wrist. J Bone Joint Surg.1986. 68A:923-926.

Visuthikosol V, Chanyasawat S. Surgical treatment of de Quervain’s diseases: A clinical review of 42 cases. J Med Assoc Thai.1988.71:637-639.

Horiuchi Y, Itou Y, Nemoto T. Analysis of operative findings of de Quervain’s disease. Orthop Surg.1989; 40:199-203.

Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain's disease: A study of operative findings. Int Orthop. 1995;19(4):209-211.

Gousheh J, Yavari M, Arasteh E. Division of the First Dorsal Compartment of the Hand into Two Separated Canals: Rule or Exception? Archives of Iranian Medicine.2009:19:52-54.

Choi SJ, Ahn JH, Lee YJ, Ryn DS, Lee JH, Jung SM, et al. De Quervain Disease: US Identifi cation of Anatomic Variations in the First Extensor Compartment with an Emphasis on Sub compartmentalization. Radiology.2011;260(2):480-486.

Lee HJ, MD, Kim PT, Aminata IW, Hong HP, Yoon JP, Jeon IH. Surgical release of the first extensor compartment for refractory de Quervain’s Tenosynovitis: Surgical findings and functional evaluation Using DASH Scores. Clinics in Orthopedic Surgery.2014;6:405-409.

Pires Junior PR, Pires PR, de Andrade AP, Lima SM. Surgical and anatomical studies on De Quervain’s tenosynovitis syndrome: Variations in the first extensor compartment. Hand Microsurg.2016;5(2):50-55.

Muckart RD. Stenosing vaginitis of Abductor Pollicis Longus and Extensor Pollicis Brevis at radial styloid (de Quervain's disease). Clin Orthop. 1964;33:201-8.




How to Cite

Israr Ahmad, Khadim Hussain, Zeeshan Khan, Salik Kashif, Mohammad Saeed, & Muhammad Arif Khan. (2020). Intra operative Anatomical variations of the first extensor compartment of the wrist in patients of de Quervain’s disease. Journal of Pakistan Orthopaedic Association, 32(03), 153–157. Retrieved from