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Release of the First Dorsal Compartment with Fascial Reconstruction

Patients who have persistent symptoms after nonoperative management are best treated by release of the first dorsal compartment. A transverse incision just distal to the tip of the radial styloid may be used. The skin is carefully incised, avoiding injury to branches of the superficial radial nerve, which lie directly below the dermis, superficial to the subcutaneous fat (Fig. 22-10). The scissors is held vertically to gently spread longitudinally down to the tendon sheath. Ragnell retractors are used on either side of the tendon to expose it, retracting branches of the superficial radial nerve; self-retaining retractors or overzealous retraction may cause neurapraxia. The sheath proximal and distal to the incision is dissected free of the superficial soft tissues, including small nerve branches. The sheath is sharply incised dorsal to its longitudinal equator to prevent volar subluxation of the tendons during wrist …