Journal of Pain Research (Dec 2022)
Percutaneous Release of the First Extensor Tendon Compartment in De Quervain’s Disease by Acupotomy with US-Guidance: A Cadaveric Study
Abstract
Yifeng Shen,1,2 Qiaoyin Zhou,1,3 Xiaojie Sun,4 Shiliang Li,1,3,4 Weiguang Zhang5 1College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, People’s Republic of China; 2Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 3Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, People’s Republic of China; 4Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 5Health Science Center, Peking University, Beijing, People’s Republic of ChinaCorrespondence: Shiliang Li, Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China, Email [email protected] Weiguang Zhang, Health Science Center, Peking University, Beijing, People’s Republic of China, Email [email protected]: De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance.Methods: Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study.Results: Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment.Conclusion: Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.Keywords: de Quervain’s disease, tendonitis, acupotomy, acupuncture, ultrasound guidance, anatomy
