De Quervain Tenosynovitis: Anatomical Variants of the First Dorsal Compartment and Their Role in Ultrasound-Guided Injection and Surgical Management — A Narrative Review
DOI:
https://doi.org/10.56929/jseaortho-2026-0309Keywords:
De Quervain tenosynovitis, first dorsal compartment, anatomical variant, ultrasonography, abductor pollicis longus, extensor pollicis brevisAbstract
Purpose: De Quervain tenosynovitis is a common cause of radial wrist pain and is characterized by stenosing tendinopathy of the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment. Increasing evidence suggests that the anatomical variants within this compartment contribute to disease development and treatment failure. To summarize the current evidence on anatomical variations in the first dorsal wrist compartment, their detection using ultrasound, and their implications for injection-based and surgical management of de Quervain tenosynovitis.
Methods: Studies published between 2015 and 2025 on de Quervain stenosynovitis, first dorsal compartment anatomy, ultrasonography, injection therapy, and surgical outcomes were included.
Results: Inter-tendinous septation and subcompartmentalization of the abductor pollicis longus and extensor pollicis brevis tendons were more prevalent in patients with de Quervain tenosynovitis than in controls and were associated with persistent symptoms after conventional corticosteroid injection or surgical release. Ultrasound demonstrates high sensitivity and specificity for detecting septa, multiple tendon slips, and subcompartments and reliably maps adjacent neurovascular structures. Ultrasound-guided corticosteroid injections, hydrodissection, platelet-rich plasma injection, and percutaneous release techniques have shown improved targeting of pathological compartments and favorable clinical outcomes. In surgical management, failure to recognize and decompress the separate subcompartments is a key cause of residual pain and recurrence.
Conclusions: Anatomical variants of the first dorsal compartment are common and clinically significant in de Quervain stenosynovitis. The routine use of ultrasound to identify anatomical variants can optimize the selection and execution of both nonsurgical and surgical treatments, potentially improving outcomes and reducing recurrence.
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