Gliding resistance of the extensor pollicis brevis tendon and abductor pollicis longus tendon within the first dorsal compartment in fixed wrist positions.
OBJECTIVE
While the etiology of de Quervain's disease is unknown, repetitive motion coupled with awkward wrist position and septation within the first dorsal compartment are considered causative factors. We hypothesize that these conditions might produce high gliding resistance, which could then induce micro-damage of the tendons and retinaculum. The purpose of this study was to measure the gliding resistance of the extensor pollicis brevis and abductor pollicis longus tendons within the first dorsal compartment in a human cadaver model.


METHODS
Fifteen human cadaver wrists, which included eight septation and seven non-septation wrists in the first dorsal compartment, were used. Gliding resistance of the extensor pollicis brevis and abductor pollicis longus tendons was measured in seven wrist positions: 60 degrees extension, 30 degrees extension, 0 degrees, 30 degrees flexion, 60 degrees flexion in neutral deviation and 30 degrees ulnar deviation, 15 degrees radial deviation in neutral extension/flexion.


RESULTS
The overall gliding resistance was not different between septation and non-septation wrists (0.21 versus 0.19 N for abductor pollicis longus and 0.21 versus 0.15 N for extensor pollicis brevis, respectively), but there was a significant effect on gliding resistance due to wrist position (p<0.05) in both tendons. Interaction between wrist position and septation status was observed in the extensor pollicis brevis tendon (p<0.05). With septation, the gliding resistance of the extensor pollicis brevis was significantly higher in 60 degrees wrist flexion (0.51 N) compared to all other wrist positions tested (all less than 0.26 N) (p<0.05). In the non-septation group, gliding resistance was significantly higher in 60 degrees flexion (0.20 N) and 60 degrees extension (0.22 N) compared to the other five wrist positions (all less than 0.15 N) (p<0.05). Although no significant difference was observed, the extensor pollicis brevis tendon with septation tended to have higher gliding resistance than that without septation in wrist flexion. In 60 degrees of wrist flexion the abductor pollicis longus tendon had significantly higher gliding resistance (0.33 N) than the other wrist positions (all less than 0.26 N) (p<0.05).


CONCLUSIONS
A combination of septation and wrist position significantly affected extensor pollicis brevis tendon gliding resistance in this cadaver model. These factors may contribute to the development of de Quervain's disease.
Kutsumi
Keiji
K
Orthopedic Biomechanics Laboratory, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
Amadio
Peter C
PC
Zhao
Chunfeng
C
Zobitz
Mark E
ME
An
Kai-Nan
KN
D001696:Biomechanical Phenomena; D006801:Humans; D013710:Tendons / Q000502:physiology*; D013717:Tenosynovitis / Q000209:etiology; D014955:Wrist Joint / Q000502:physiology*