FUNCTIONAL OUTCOME OF SURGICAL RELEASE OF DE QUERVAIN’S DISEASE

medicine

Background: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendon occurs typically in adults 30-50 years old. Various modalities of treatment has been proposed for De Quervain’s Disease. The outcome of conservative treatment for this condition has shown variable results. Surgery has outstanding results when conservative measures fail to take care of the problem. Aims and Objectives: To study the functional outcome of surgical release of De Quervain’s disease.Materials and Methods:Observational prospective study was carried out in Outpatient Department (OPD) of Western Regional Hospital, Pokhara in patient of age group 16-60 years who didn’t improve with conservative treatment after a period of 6 weeks and then will be undergoing surgical release for the same problem.Time taken to return to normal activities ,anatomical variant of tendons in first extensor compartment ,complications,VAS score and effectiveness of the surgery using modified Mayo wrist score will be taken under consideration. Results:Out of 30 patients taken into study ,27(90%) were female and 3(10%) were male with female:male ratio of 9:1. 17(57%) were right hand and 13(43%) were left hand involvement and 24(80%) were right hand dominant and 6(20%) were left hand dominant. Maximum number of patients allocated in our study falls in age group of 31-45 years with mean age group being 40.2 years(50%) followed by age group of 46-60 years(30%) with least number in age group of 15- 30 years (20%).20 cases (66.67%) were house wives,6(20%) were student,3(10%) were job holders.53.3% patients had symptoms of duration 6-12 months followed by one year duration(13.3%) and least in less than six months duration(13.3%).Duration of surgery was in the range of 10-25 minutes with mean time of 12 minutes. Time taken to return to job was within six weeks with mean duration of 2 weeks.2 patients had persistent pain however, it was managed with analgesics. Preoperative VAS score 7.4 that improved to 2.1 at 2 weeks Postoperatively(POD),1.43 at 6 weeks and 1.13 at 6 months.26(86.67%) had excellent ,3(10%) had good and 1(3.33%) had fair results at 6 months follow up which was analysed by Modified Mayo Wrist Score. Conclusion: This study showed that functional outcome of surgical release of refractory de Quervain’s disease is excellent with minimum complications and surgery should be considered in those patients who do not respond to conservative treatment up to 6 weeks.

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