The first extensor compartment is a fibro-osseous tunnel over the radial styloid containing the abductor pollicis longus and extensor pollicis brevis tendons, reinforced by a septum that may create sub-compartments in up to 34% of individuals.
Constrains the APL and EPB tendons over the radial styloid during forearm rotation and thumb movement, preventing bowstringing. The tunnel's rigid walls become the constricting element in de Quervain stenosing tenosynovitis.
De Quervain disease is the classic first compartment pathology — tenosynovitis of the APL and EPB produces radial wrist pain with a positive Finkelstein test. The septum creating separate sub-compartments for APL and EPB must be released individually to prevent failed decompression. Ultrasound identifies sub-compartments pre-operatively.
Stenosing tenosynovitis of APL and EPB in the first extensor compartment producing radial wrist pain, treated by compartment release with care to release all sub-compartments.
Persistent symptoms after first compartment release due to unreleased EPB sub-compartment, requiring revision surgery for targeted septum release.
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