Pulley Reconstruction Following Surgical Release of DC1 Pulley in De Quervain’s Tenosynovitis: Surgical Technique and Case Series

Document Type : TECHNICAL NOTE


Department of Orthopaedics, ESI Hospital Rohini, Delhi, India


De Quervain’s disease (DQD) is tenosynovitis of the first dorsal compartment (DC1) of the wrist between the osteofibrous 
tunnel and the tendons involving the APL and EPB sheaths at the radial styloid. Surgical intervention is indicated when 
pain does not resolve despite 3 to 6 months of conservative management. Release of the first dorsal compartment is an 
effective treatment of DQD. In addition to surgical release, we performed pulley reconstruction using a new technique 
in the present series of 20 patients which has not been previously described with a followup of over 1 year. All patients 
showed a consistent improvement in VAS score at over one year followup with resolution of Finkelstein, Eichoff and 
WHAT test. Only one temporary neuropraxia was encountered due to stretching/scar entrapment of superficial branch of 
radial nerve. Our innovative technique of pulley reconstruction is not only easy to understand and perform but has shown 
consistent result in the 20 cases operated with this technique with a follow up of at least 1 year. The technique has the 
distinct advantage of having a quick learning curve and gives reliable, lasting results without complications or recurrence. 
Level of evidence: IV


  1. De Quervain In La Chaux-De-Fonds F. On a Form of Chronic Tendovaginitis. Journal of Hand Surgery. 2005;30(4):388–91.
  2. Clarke MT, Lyall HA, Grant JW, Matthewson MH. The Histopathology of De Quervain’s Disease. Journal of Hand Surgery. 1998;23(6):732–4.
  3. Kay NRM. De Quervain’s Disease: Changing pathology or changing perception? Journal of Hand Surgery. 2000;25(1):65–9.
  4. Garçon JJ, Charruau B, Marteau E, Laulan J, Bacle G. Results of surgical treatment of De Quervain’s tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthopaedics & Traumatology: Surgery & Research. 2018;104(6):893–6.
  5. Kim J-H, Yang S-W, Ham H-J, Kim J-P. Tendon Subluxation After Surgical Release of the First Dorsal Compartment in De Quervain Disease. Ann Plast Surg. 2019;82(6):628–35.
  6. Rogozinski B, Lourie GM. Dissatisfaction After First Dorsal Compartment Release for de Quervain Tendinopathy. The Journal of Hand Surgery. 2016;41(1):117–9.
  7. Altay MA, Erturk C, Isikan UE. De Quervain’s disease treatment using partial resection of the extensor retinaculum: A short-term results survey. Orthopaedics & Traumatology: Surgery & Research. 2011;97(5):489–93.
  8. Kumar K. Outcome of longitudinal versus transverse incision in de Quervain’s disease and its implications in Indian population. Musculoskelet Surg. 2016;100(1):49–52.
  9. Salim B, Ansari MT, Kumar VS, Goyal A, Malhotra R. Is Pulley Reconstruction Better Than Pulley Release for De Quervain’s Tenosynovitis? A Double-Blind Randomized Controlled Trial. Journal of Wrist Surgery. 2021;10(05):377-84.
  10. Bakhach J, Sentucq-Rigal J, Mouton P, Boileau R, Panconi B, Guimberteau J-C. La plastie d’expansion en Oméga « Ω » : une nouvelle technique de traitement chirurgical de la ténosynovite de De Quervain. Annales de Chirurgie Plastique Esthétique. 2006;51(1):67–73.
  11. Scheller A, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of de Quervain’s stenosing tenosynovitis. International Orthopaedics (SICOT). 2009;33(5):1301–3.
  12. Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for de Quervain’s tenosynovitis. Cochrane Musculoskeletal Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2009 [cited 2021 Jun 20]; Available from: http://doi.wiley.com/10.1002/14651858.CD005616.pub2
  13. Richie III CA, Briner WW. Corticosteroid Injection for Treatment of de Quervain’s Tenosynovitis: A Pooled Quantitative Literature Evaluation. The Journal of the American Board of Family Medicine. 2003;16(2):102–6.
  14. Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. The Journal of Bone & Joint Surgery. 1986;68(6):923–6.
  15. Wright PE. Carpal Tunnel, Ulnar Tunnel, and Stenosing Tenosynovitis. In: Campbell’s Operative Orthopaedics [Internet]. Elsevier; 2008 [cited 2021 Jun 20]. p. 4285–309. Available from: https://www.elsevier.com/books-and-journals/deleted-doi
  16. Arons MS. de Quervain’s release in working women: A report of failures, complications, and associated diagnoses. The Journal of Hand Surgery. 1987;12(4):540–4.
  17. Belsole RJ. deQuervain’s tenosynovitis diagnostic and operative complications. Orthopedics. 1981;4(8):899-903.
  18. Ilyas AM, Ast M, Schaffer AA, Thoder J. de Quervain Tenosynovitis of the Wrist: Journal of the American Academy of Orthopaedic Surgeons. 2007;15(12):757–64.
  19. White GM, Weiland AJ. Symptomatic palmar tendon subluxation after surgical release for de Quervain’s disease: A case report. The Journal of Hand Surgery. 1984;9(5):704–6.
  20. Collins ED. Radial Ridge Excision for Symptomatic Volar Tendon Subluxation Following de Quervain’s Release. Techniques in Hand & Upper Extremity Surgery. 2014;18(3):143–5.
  21. van der Wijk J, Goubau J, Mermuys K, van Hoonacker P, Vanmierlo B, Kerckhove D, et al. Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results. Jnl Wrist Surg. 2015;04(03):200–6.
  22. Ramesh R, Britton JM. A retinacular sling for subluxing tendons of the first extensor compartment: A CASE REPORT. The Journal of Bone and Joint Surgery British volume. 2000;82-B(3):424–5.
  23. ACAR E, GÜLTEKİN BA. De Quervain Tenosinovit Cerrahisinde Longitudinal İnsizyon mu? Transvers İnsizyon Mu?. Kocaeli Tıp Dergisi. 2020;9(3):106-10.
  24. Kang HJ, Koh IH, Jang JW, Choi YR. Endoscopic versus open release in patients with de Quervain’s tenosynovitis: A randomised trial. The Bone & Joint Journal. 2013;95-B(7):947–51.
  25. Slade JF, Merrell G. Endoscopic Release of the First Dorsal Extensor Tendon Compartment. In: Techniques in Wrist and Hand Arthroscopy [Internet]. Elsevier; 2007 [cited 2021 Jun 20]. p. 253–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780443066979500370