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.
| Location | Radial side of the wrist, over the radial styloid |
|---|---|
| Boundaries |
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| Contents |
Keeps the thumb abductor and short extensor tendons close to the radial styloid during thumb and wrist movement; narrowing of this tunnel causes de Quervain 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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