For this reason, we use a small longitudinal incision from the tip of the radial styloid distally for approximately 1.5 cm. 9 Longitudinal incisions generally lead to fewer superficial nerve injuries than do transverse incisions. These branches travel in an ulnar direction over the dorsum of the hand, supplying the radial three digits (thumb, index finger, and long finger). The main trunk of the superficial radial sensory nerve continues distally and divides into three to five branches that pass over the extensor pollicis longus tendon. The first branch comes off in a radial direction and continues on to the volar aspect of the forearm and innervates the radial aspect of the thumb. Several branches of the superficial radial sensory nerve lie within the subcutaneous fat overlying the first dorsal compartment ( Figure 2). The first principle is that care must be taken to protect the superficial radial nerve and its branches. Both bulk and tethering effects may induce pain by directly stretching synovial tissue, especially when the synovial tissue is inflamed or fibrotic, as may be the case in de Quervain disease. The synovial tissue around the EPB and APL tendons also might be stretched in the Finkelstein testing position, causing a tethering effect. In the Finkelstein test, when the thumb is in full flexion and the wrist is in ulnar deviation, the EPB muscle belly is pulled into the first compartment, resulting in a bulk effect. Anatomically, the musculotendinous junction of the EPB tendon is close to the first compartment. The test result is positive when excruciating pain over the styloid tip is generated by grasping the patient’s thumb and quickly abducting the hand ulnarward. In 1930, Finkelstein 4 described a clinical test that is pathognomonic of the disease. Physical examination often reveals localized swelling and tenderness over the first dorsal compartment, extending 1 to 2 cm proximal to the radial styloid process.
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