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=====Title=====
Omega “Ω” Pulley Plasty for Surgical Management of DeQuervain’s Disease

====Abstract====
===Background:=== 
DeQuervain tenosynovitis, refractory to medical conservative treatment, has been traditionally treated by a simple division of the pulley, a procedure associated with several complications. Many authors attempted to prevent these complications by describing techniques of pulley reconstruction after its release necessitating suturing the different flaps and subsequently promoting extensor tendons adhesions. The authors present an alternative procedure for the first extensor compartment pulley decompression: “Omegaplasty”. 

===Methods:=== 
25 Patients with 29 DeQuervain tenosynovitis cases were enrolled in a prospective, nonrandomized clinical trial from 2012 to 2016. At enrollment they were offered the option of Omegaplasty as a surgical treatment modality for their cases. The procedure is based on liberating the anterior attachment of the pulley from the anterior lip of the styloïd process while respecting its continuity with the periosteal flap as well as promoting expansion of the tunnel volume. All operated patients were evaluated using the “Opposition Kapandji Score”. 

===Results:=== 
The authors present the results of 29 different “Omegaplasty” procedures. Based on the Kapandji opposition score, twenty cases scored 10/10 while the remaining nine cases yielded an 8/10 score each. 

===Conclusions:=== 
The described technique is simple, reliable and respects the extensor tendons gliding physiology and biodynamics. By preserving the anatomical continuity of the first extensor compartment pulley at the wrist, the risk of adhesion formation is reduced. The preliminary results are encouraging and provide the “Ω” plasty the potential to be considered as a surgical option for treatment of De Quervain Tenosynovitis.

====Commentary====
De Quervain's tenosynovitis is a very common condition. Most patients can be treated with some rest, activity modification, splinting, oral and topical medication. Some times a steroid injection is necessary and can help temporarily or permanently resolve the condition. 

Surgery is reserved for patients with persistent and recurrent symptoms after conservative treatment. In my own practice, this is a limited group of all patients.  

?history of surgery?

Subluxation of tendon as complication. The authors of this paper, xxx and xxxx, describe an alternative procedure to prevent this uncommon but disabling complication using a simple surgical technique. 

It is an adaptation of a technique used to expand the A2 and A4 pulleys for digital flexor tendon repair. The name of the procedure comes from the appearance of the pulley in cross-section after the the procedure is done.

In their report, surgery was offered in all patients after a period of conservative treatment. In their report, all their patients improved with splinting, but recurred after some time. The patients also received a variable number of steroid injections (from 0 to 3 prior to operative intervention).

Outcome scoring using the Kapandji Score

====Facebook Post====
Surgical release of the first extensor pulley is a reliable treatment in recurrent or refractory DeQuervain's tenosynovitis. There is a small but real risk of symptomatic tendon subluxation after the surgery, and various techniques have been described to prevent this problem.

In this article from the journal, Joseph Bakhach, Bachar Chaya, and Nazareth J. Papazian from @AUBMC describe a simple technique to prevent this problem. 

The article is available after free registration when you follow the doi link.

Bakhach, J., Chaya, B., & Papazian, N. (2018). Omega “Ω” Pulley Plasty for Surgical Management of DeQuervain’s Disease. The Journal of Hand Surgery (Asian-Pacific Volume), 23(02), 170–175. https://doi.org/10.1142/S2424835518500169

#jhsapfssh #dequervain #handsurgery

====Source====
Bakhach, J., Chaya, B., & Papazian, N. (2018). Omega “Ω” Pulley Plasty for Surgical Management of DeQuervain’s Disease. The Journal of Hand Surgery (Asian-Pacific Volume), 23(02), 170–175. https://doi.org/10.1142/S2424835518500169
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