Anat Cell Biol.  2024 Jun;57(2):246-255. 10.5115/acb.24.011.

Relationship to the superficial radial nerve and anatomic variations of the first extensor compartment in Thai population: a basis for successful de Quervain tenosynovitis treatment

• Pasiphol K
• Agthong S
• Thamrongskulsiri N
• Dokthien S
• Huanmanop T
• Tabtieng T
• Chentanez V

• KMID: 2556569
• DOI: http://doi.org/10.5115/acb.24.011

Abstract

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

Keyword

de Quervain disease; First extensor compartment anatomy; Superficial radial nerve lesion

Figure

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  Fig. 1 The diagram of the right wrist demonstrates landmarks and structures investigated in this study. 1, distal border of ER; 2, proximal border of ER; d, distance to the closest branch of superficial radial nerve; APL, abductor pollicis longus; EPB, extensor pollicis brevis; ER, extensor retinaculum; R, radial styloid process; SR, branches of the superficial radial nerve.

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  Fig. 2 Types of the first extensor compartment septa. (A) An incomplete septum separating EPB and APL tendons. (B) A complete septum. (C) No septum. 1, distal border of ER; 2, proximal border of ER; 3, proximal border of the incomplete septum; APL, abductor pollicis longus; EPB, extensor pollicis brevis; ER, extensor retinaculum; SR, branches of superficial radial nerve.

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  Fig. 3 Relation of the SRN and first EC. (A) Right cadaveric wrist showing two branches of SRN lying on the ER over the first EC. (B) Left cadaveric wrist showing the LACN lying on the ER over the first EC and a communicating branch between SRN and LACN. 1, distal border of ER; 2, proximal border of ER; APL, abductor pollicis longus; ER, extensor retinaculum; EPB, extensor pollicis brevis; LACN, lateral antebrachial cutaneous nerve; SRN, superficial radial nerve; EC, extensor compartment.

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  Fig. 4 Absence of EPB in the first extensor compartment. A slip from APL (asterisk) inserting at the proximal phalanx. EPB, extensor pollicis brevis; APL, abductor pollicis longus; EPL, extensor pollicis longus; ER, extensor retinaculum; 1, distal border of ER; 2, proximal border of ER.

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  Fig. 5 Photographs and diagrams illustrating an EPL split tendon and three sub-compartments within the first EC. (A) Before ER cut, two tendons distal to the first EC. (B) After the ER cut, one EPB tendon and a split tendon from EPL (asterisk). (C) Course of the split EPL tendon. (D) Cross-section of the 1st EC showing three sub-compartments and contents. 1, distal border of ER; 2, proximal border of ER; asterisk, split EPL tendon; #common insertion of EPB and EPL at distal phalanx of thumb. APL, abductor pollicis longus tendon; EPB, extensor pollicis brevis tendon; EPL, extensor pollicis longus tendon; ER, extensor retinaculum; EC, extensor compartment.

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  Fig. 6 Illustration of the extension of EPB muscle belly into the first EC. (A) Right cadaveric wrist with the extension of the EPB muscle belly into the first EC. (B) Right cadaveric wrist without extension of EPB muscle belly. 1, distal border of the 1st EC; 2, proximal border of the 1st EC; APL, abductor pollicis longus; EPB, extensor pollicis brevis; EPL, extensor pollicis longus; ER, extensor retinaculum; EC, extensor compartment.

Reference

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