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Kuo YC, Hsieh LF, Liu YF, Chang CS. Ultrasound versus palpation-guided corticosteroid injection for de Quervain disease: A randomized controlled trial. PM R 2024. [PMID: 38647254 DOI: 10.1002/pmrj.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Corticosteroid injection effectively treats de Quervain disease, and due to the high prevalence of the intracompartmental septum in the first extensor compartment, ultrasound guidance improves injection accuracy. OBJECTIVE To compare the effectiveness, adverse events, and the recurrence rate between ultrasound-guided and palpation-guided injection in patients with de Quervain disease. DESIGN Prospective, single-blind, randomized controlled trial. SETTING Rehabilitation department of a private teaching hospital. PARTICIPANTS We enrolled 49 patients, ≥20 years of age, clinically diagnosed with de Quervain disease based on their medical history and physical examination. INTERVENTIONS Patients were randomized into two groups: ultrasound-guided and palpation-guided injection. Both groups received a mixture of 10 mg triamcinolone acetonide (10 mg/1 mL) and 0.3 mL 1% lidocaine. MAIN OUTCOME MEASURES The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 1 week. The secondary outcome measures were visual analog scale for pain (pain VAS) score, patient satisfaction, and adverse events or complications from the interventions at 1 week, 3 months, and 6 months. RESULTS Both groups showed improvement over time in QuickDASH scores and pain VAS (p < .001); however, no statistically significant differences were noted between the groups for either QuickDASH scores (p = .22) or pain VAS (p = .30). In addition, no statistically significant differences were found between the groups in terms of patient satisfaction (p = .76) and adverse events (p = .47, .33, .58) at the 1-week, 3-month, and 6-month follow-ups. CONCLUSIONS Both ultrasound-guided and palpation-guided injections effectively treated de Quervain disease. During a 6-month follow-up, there were no statistically significant differences between the groups in pain relief, upper limb function, or patient satisfaction. However, the palpation-guided group showed a tendency for more recurrence and skin side effects.
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Affiliation(s)
- Ying-Chen Kuo
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ya-Fang Liu
- Administration Division, Research Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Sung Chang
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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2
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Beydoğan E, Yalçın A. Is 2D SWE sufficient as clinical diagnosis in patients with plantar fasciitis? Acta Radiol 2021; 64:147-152. [PMID: 34851153 DOI: 10.1177/02841851211058928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The use of shear wave elastography (SWE) seems to be an important imaging method in the diagnosis of plantar fasciitis (PF). PURPOSE To compare patients diagnosed with PF with similar and young healthy control groups in terms of B-mode ultrasound (US) and SWE results and to evaluate the elasticity of the plantar fascia. MATERIAL AND METHODS A total of 140 feet of 70 participants were evaluated, including 30 patients and 40 healthy individuals as the control. Clinical, B-mode US, and SWE evaluations were performed for each patient. In addition, American Orthopedic Foot and Ankle Score (AOFAS) was calculated to evaluate pain and foot function in both groups. RESULTS Of the patients in the PF group, 40 (88%) were women and the healthy control groups had similar sex distributions (P = 0.23). The AOFAS score was lower in feet with PF compared to the other groups (P < 0.001). Of 30 patients with PF, 15 (50%) had bilateral PF and 15 (50%) unilateral PF. In addition, ≥4 mm thickness measurement, which was used as a diagnostic criterion for PF as a US finding, could be shown in 11 (73.3%) patients with unilateral PF and 6 (40%) patients with bilateral PF. CONCLUSION In conclusion, the evaluation of the diagnosis of PF with clinical findings and regular follow-up of measurements with SWE can provide measurement results with higher sensitivity in the diagnosis of PF.
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Affiliation(s)
- Engin Beydoğan
- Van Research and Training Hospital, Department of Radiology, Van, Turkey
| | - Atilla Yalçın
- Taksim Research and Training Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
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3
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Rosskopf AB, Martinoli C, Sconfienza LM, Gitto S, Taljanovic MS, Picasso R, Klauser A. Sonography of tendon pathology in the hand and wrist. J Ultrason 2021; 21:e306-e317. [PMID: 34970442 PMCID: PMC8678645 DOI: 10.15557/jou.2021.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022] Open
Abstract
Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high-quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.
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Affiliation(s)
- Andrea B Rosskopf
- Radiology, Balgrist University Hospital, University of Zurich, Switzerland.,Radiology, ARISTRA, Switzerland
| | - Carlo Martinoli
- Department of Health Science (DISSAL), Università di Genova, Italy.,IRCCS, Ospedale Policlinico San Martino, Italy
| | - Luca M Sconfienza
- IRCCS, Istituto Ortopedico Galeazzi, Italy.,Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Mihra S Taljanovic
- Department of Radiology, University of New Mexico, United States.,Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, United States
| | | | - Andrea Klauser
- Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Austria
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4
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Mandiroglu S, Alemdaroglu E. Idiopathic carpal tunnel syndrome and de Quervain's tenosynovitis: is there an association? Somatosens Mot Res 2021; 38:353-356. [PMID: 34632917 DOI: 10.1080/08990220.2021.1986378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM In this study, we aimed to investigate frequency of de Quervain's tenosynovitis (DQT) in patient with idiopathic carpal tunnel syndrome (ICTS). MATERIAL AND METHODS We evaluated 356 hands of 310 patients who applied with the pre-diagnosis of ICTS. Patients who have pain over the radial styloid, pain on movement, tenderness over the first dorsal extensor compartment and also positive Finkelstein's test were accepted clinically DQT. Presence of DQT was confirmed by ultrasonography. Motor and sensory conductions of median and ulnar nerves were studied in every hand with the pre-diagnosis of ICTS. RESULTS We determined ICTS in 302 (85%) hands. De Quarvain's tenosynovitis ratio was found to be 9.9% in hands with ICTS (n:302). In patients with ICTS and DQT in the same hand, the male-to-female ratio is 1/3. There were 29 cases (22 female, 7 male) with ICTS and DQT. Of the 30 hands with ICTS and DQT together; 18 had mild, nine had moderate, and 3 had severe ICTS. CONCLUSION This is the first study that evaluates the DQT and ICTS together. We found that patients with ICTS have a prevalence higher than normal population to have DQT. We suppose that considering DQT in patients with the pre-diagnosis of ICTS during clinical evaluation has a positive impact on clinical follow-up and treatment of these patients.
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Affiliation(s)
- Sibel Mandiroglu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Alemdaroglu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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5
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Rosskopf AB, Taljanovic MS, Sconfienza LM, Gitto S, Martinoli C, Picasso R, Klauser A. Pulley, Flexor, and Extensor Tendon Injuries of the Hand. Semin Musculoskelet Radiol 2021; 25:203-215. [PMID: 34082447 DOI: 10.1055/s-0041-1727196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.
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Affiliation(s)
- Andrea B Rosskopf
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Radiology, ARISTRA, Zurich, Switzerland
| | - Mihra S Taljanovic
- Department of Medical Imaging, University of Arizona, Business, SimonMed Imaging, Scottsdale, Arizona
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Carlo Martinoli
- Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
| | - Riccardo Picasso
- Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Innsbruck, Austria
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Henry TW, Tulipan JE, Beredjiklian PK, Matzon JL, Lutsky KF. Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis? J Wrist Surg 2021; 10:48-52. [PMID: 33552695 PMCID: PMC7850799 DOI: 10.1055/s-0040-1716522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Background The routine use of plain radiography represents a significant expenditure and has been proven unnecessary in several orthopedic conditions. The utility of plain radiographs in the diagnosis of De Quervain's tenosynovitis (DeQ) is not clear. Questions/Purpose This study evaluates whether plain radiographic findings routinely predict the need for surgery or alter treatment courses in the initial diagnosis of DeQ. Patients and Methods A total of 200 patients who received wrist X-rays and had a diagnosis of DeQ were retrospectively selected at random. Their images were evaluated for relevant findings, including radial styloid abnormalities, arthritis, and tendon calcification. A chart review was performed to determine whether these X-rays altered the treatment courses. Results Of the 200 patients, 141 (69.1%) cases had at least one positive radiographic finding. Carpometacarpal joint (CMC) arthritis was the most common finding, seen in 63 (30.9%) cases. Of all patients, 141 (69.1%) were treated with corticosteroid injection only, 54 (26.5%) with corticosteroid injection and ultimately surgery, and 9 (4.4%) with surgery alone. There were no significant differences in the rates of surgery with positive X-ray findings. There were no cases in which radiographic findings resulted in a change in management, per the report of the treating physician. Conclusions Despite the high proportion of positive findings on X-ray, no radiographic findings altered the course of treatment in patients with isolated DeQ. Obtaining plain radiographs for isolated DeQ represents a significant cost and should be reserved for cases in which the results are preemptively deemed likely to influence the treatment course. Level of Evidence This is a level IV study.
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Affiliation(s)
- Tyler W. Henry
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jacob E. Tulipan
- Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Pedro K. Beredjiklian
- Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Jonas L. Matzon
- Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Kevin F. Lutsky
- Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Bhattacharya AK, Awan OA, Fenerty S, Taqi I, Jonnalagadda P, Ling S, Ali S. Repetitive Strain Injuries of the Upper Extremity: Imaging of Tendon Pathology and Compressive Neuropathies. Curr Probl Diagn Radiol 2020; 50:512-522. [PMID: 32826098 DOI: 10.1067/j.cpradiol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022]
Abstract
Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.
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Affiliation(s)
| | - Omer A Awan
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sarah Fenerty
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Irfan Taqi
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | | | - Stephen Ling
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA
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Azeem N, Ariff M. Association of Clinical and Radiological Features in Various Repetitive Stress Injuries. Cureus 2020; 12:e7692. [PMID: 32431971 PMCID: PMC7233502 DOI: 10.7759/cureus.7692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess the clinical and radiological features of repetitive stress injuries (RSIs), specifically de Quervain’s (DQ) disease, tennis elbow (TE), and plantar fasciitis (PF). Methods This was an observational study conducted for eight months (March 2019 to September 2019) at the Orthopedic Department in collaboration with the Radiology Department. Clinically diagnosed RSI patients from both genders, aged between 30 and 50 years, were included in the study. Clinical features that were considered include pain, swelling, and site of injury. Radiological findings from ultrasound, X-ray, and magnetic resonance imaging (MRI) were identified in all participants of the study. Data were analyzed using SPSS Version 21 (IBM Corp., Armonk, NY, USA). Data were represented as frequency and percentages. Results There were a total of 82 patients (40 males,42 females) with repetitive stress injury (RSI), with a mean age of 42.63±8.53 years. Of the 82 patients, 34 (41.4%) had DQ disease, 28 (34.1%) had TE, and 20 (24.4%) had PF. Pain and swelling were observed in all patients. In TE, the most affected site was the right lateral epicondyle process. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, and calcification in soft tissues. Cozen’s test was positive in most patients. In DQ, the most affected sites were left and right radial styloid processes. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor, cortical erosion, and periosteal reaction. Finkelstein’s test was also positive in most patients. In PT, the most affected site was the left heal plantar surface. The common radiological findings were hypoechoic fascia, increased thickness of fascia (>4.5 mm), increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, calcaneal spur, periosteal reaction, and calcification in soft tissues. Cozen’s and Finkelstein’s tests were also positive in most patients. Conclusions History, physical examination, laboratory findings, and imaging modalities all are important tools for the differential diagnosis of RSI. Our study results showed that if some clinical findings fail to diagnose any RSI, then ultrasound, X-ray, and magnetic resonance imaging (MRI) are the best and useful options before treatment.
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Affiliation(s)
| | - Madiha Ariff
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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9
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Ma T, Song L, Ning S, Wang H, Zhang G, Wu Z. Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming. INTERNATIONAL ORTHOPAEDICS 2019; 43:2587-2592. [PMID: 31463625 DOI: 10.1007/s00264-019-04389-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.
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Affiliation(s)
- Tianxiao Ma
- Department of Orthopaedic Surgery, The Orthopedics Hospital of Xingtai City, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Lihua Song
- Department of Orthopaedic Surgery, The Orthopedics Hospital of Xingtai City, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China.
| | - Shenghua Ning
- Department of Orthopaedic Surgery, The Orthopedics Hospital of Xingtai City, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Huiwang Wang
- Department of Orthopaedic Surgery, The Orthopedics Hospital of Xingtai City, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China
| | - Guisheng Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Zhanyong Wu
- Department of Orthopaedic Surgery, The Orthopedics Hospital of Xingtai City, NO.202 Bayi Street, Xingtai, Hebei, People's Republic of China.
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10
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review common hand and wrist injuries experienced by tennis players. RECENT FINDINGS A myriad of different wrist pathologies can be seen in tennis players ranging from metacarpal and carpal stress fractures to triangular fibrocartilage injuries and ulnar impaction. These vary depending upon the nature of the player, stroke mechanics, and time point within the season. A broad differential should guide work-up and management of wrist pain in tennis players.
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Affiliation(s)
- Joseph A Gil
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55901, USA
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55901, USA.
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Gheita TA, Eesa NN. Rheumatology in Egypt: back to the future. Rheumatol Int 2018; 39:1-12. [PMID: 30406299 DOI: 10.1007/s00296-018-4192-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
Abstract
Medical knowledge in ancient Egypt had a remarkable reputation since rulers of other empires used to request the pharaoh to send them their best physician to treat their beloved ones. Many rheumatologic conditions as giant-cell arteritis, reactive arthritis and other forms of spondyloarthritis have been identified in ancient Egyptian materials. Rheumatologists in Egypt are enormously expanding and mastering the tools that aid them in enhancing the management of rheumatic diseases. More Egyptian rheumatologists are actively participating in the annual European League Against Rheumatism (EULAR) and American College of Rheumatology conferences and those attached to well known state of the art centers are increasing. EULAR certified Egyptian MSUS trainers are effectively performing regionally. This review throws light on the rheumatology practice in Egypt, its progress from ancient times passing through Egyptian medical healthcare services, education systems for rheumatologists, rheumatology associations, an overview on the spectrum of rheumatic diseases through publications in the field till future perspectives. Rheumatology in Egypt is an actively growing and dynamic specialty of medicine with considerable contributions to the world's literature. These days, persistent efforts are mandatory to raise the standard of clinical and basic research, to optimize clinical practice with regard to new biologics, to develop tailored and targeted therapies for the rheumatic diseases, and to meet the medical demands of the exponentially increasing Egyptian population. Opportunities and challenges discussed high-lighten future perspectives needed to boost the rheumatology practice in Egypt.
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Affiliation(s)
- Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Nahla N Eesa
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Bing JH, Choi SJ, Jung SM, Ryu DS, Ahn JH, Kang CH, Shin DR. Ultrasound-guided steroid injection for the treatment of de Quervain's disease: an anatomy-based approach. Skeletal Radiol 2018; 47:1483-1490. [PMID: 29730702 DOI: 10.1007/s00256-018-2958-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To suggest different ultrasound-guided steroid injection (USI) techniques based on anatomical variations of the first extensor compartment (FEC), and to evaluate the usefulness of it, in patients with de Quervain's disease. MATERIALS AND METHODS Twenty-eight patients who underwent USI for de Quervain's disease were included. Anatomical variations were classified into complete sub-compartmentalization (n = 11), distal incomplete sub-compartmentalization (n = 5), and no sub-compartmentalization (n = 12) on ultrasound. Involved sub-compartments were recorded in patients with complete sub-compartmentalization. USIs were performed based on the anatomical variations: in both sub-compartments (n = 2) or only in the affected sub-compartment (n = 9) depending on the location of tenosynovitis involvement, in patients with complete sub-compartmentalization; in proximal FEC in patients with distal incomplete sub-compartmentalization (n = 5); in the common compartment in patients with no sub-compartmentalization (n = 12). Medical charts were retrospectively reviewed for evaluation of clinical outcome at follow-up visits. RESULTS Twenty-three out of 28 patients were followed up with a mean period of 31.2 days after injection (6~87 days). Mean VAS was 7.96 before injection (range: 4 to 10), which was significantly reduced to 0.65 at rest and 1.57 during activity at follow-up visits (p < 0.05). Twenty-two out of 23 patients were satisfied with the results. The mean proportion of subjective pain reduction was 82.0% (median 95%). CONCLUSION Ultrasound-guided steroid injections using different injection techniques based on the anatomical variations of the FEC have shown to be beneficial in the management of de Quervain's disease.
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Affiliation(s)
- Jong-Hyun Bing
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Soo-Jung Choi
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea.
| | - Seung-Moon Jung
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Dae-Shick Ryu
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Jae-Hong Ahn
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Chae-Hoon Kang
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Dong-Rock Shin
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
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Gitto S, Draghi AG, Draghi F. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:51-68. [PMID: 28708327 DOI: 10.1002/jum.14313] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Goubau JF, Goubau L, Goorens CK, van Hoonacker P, Kerckhove D, Vanmierlo B, Berghs B. De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement. J Wrist Surg 2015; 4:35-42. [PMID: 25709877 PMCID: PMC4327722 DOI: 10.1055/s-0034-1398487] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is de Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the incidence of de Quervain disease during the first year following surgery. We found a particularly high incidence (17%) of de Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting de Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the development of de Quervain tendinopathy within one year after surgery.
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Affiliation(s)
- Jean F. Goubau
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Laurent Goubau
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Gent, Universiteit Gent (UG), Gent, Belgium
| | - Chul Ki Goorens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Hagelandse Orthopedische Praktijk, Regionaal Ziekenhuis Tienen, Tienen, Belgium
| | - Petrus van Hoonacker
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Diederick Kerckhove
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bert Vanmierlo
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bart Berghs
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
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Ali M, Asim M, Danish SH, Ahmad F, Iqbal A, Hasan SD. Frequency of De Quervain's tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons J 2014; 4:74-78. [PMID: 24932451 PMCID: PMC4049654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE to assess the frequency of De Quervain's tenosynovitis and its association with SMS texting. METHOD a cross-sectional survey was conducted among undergraduate students studying in different physical therapy schools of Karachi belonging to both public and private sectors. Sample size was 300 students which were selected through convenience sampling. Data was collected through self-administered questionnaire and severity of the pain was assessed through Universal Pain Assessment Tool and De Quervain's tenosynovitis was diagnosed through Finkelstein test. Data entry and analysis were done using computer software SPSS version 20. Frequency and percentages were taken for categorical variable. Chi-square was applied to determine association between different variables and Finkelstein test. P value < 0.05 was considered significant. RESULTS male/female ratio was 1:4. Regarding the use of cell phones, majority 165 (55%) were using regular cell phones, another 89 (30%) were using touch screen and 38 (13%) were using QWERTY key pads. Almost half of the students were frequently using cell phones for texting, out of them 132 (44%) texted less than 50 messages per day. Another 96 (32%) did texting between 50-100 texts. Out of 300 students who filled the questionnaire 125 (42%) students were experiencing pain in the thumb/wrist. Finkelstein test when done on students almost half (n=149) showed positive results. It was noted that as frequency of mobile phone usage increased progressively more and more people showed positive Finkelstein Test (p value 0.000). CONCLUSION the result of the study concluded that almost half of the students use their mobile phones for texting more than 50 S.M.S per day and because of their mobile key pads and high speed of texting they experienced pain and weakness over the base of the thumb/wrist which shows the De Quervain's positive in that students and there is a positive association between the thumb pain and frequent text messaging.
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Affiliation(s)
- Maryam Ali
- Ziauddin College of Physiotherapy, Karachi, Pakistan
| | - Muhammad Asim
- Ziauddin College of Physiotherapy, Karachi, Pakistan
| | - Syed Hasan Danish
- Department of Community Health Sciences, Ziauddin University, Karachi, Pakistan
| | - Farah Ahmad
- Department of Community Health Sciences, Ziauddin University, Karachi, Pakistan
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Abstract
De Quervain's disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis, caused mainly by overuse. Conventional treatments include rest, immobilisation, oral anti-inflammatory drugs, corticosteroid injection and even surgery, but none of these is established as clearly effective. Acupuncture is rarely mentioned and the points suggested are rather general-regional, tender and ah shi points. Tendinopathy is almost always associated with problems in the relevant muscles and this paper calls attention to the correct identification and needling of the affected muscles, in order to increase the specificity of acupuncture treatment.
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Diop AN, Ba-Diop S, Sane JC, Tomolet Alfidja A, Sy MH, Boyer L, Badiane M. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. ACTA ACUST UNITED AC 2008; 89:1081-4. [PMID: 18772786 DOI: 10.1016/s0221-0363(08)73912-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the role of US in the management of de Quervain's tenosynovitis. MATERIALS AND METHODS Using a high-frequency transducer (12 MHz), sagittal and axial images were obtained of the first extensor compartment. The US features of 22 symptomatic patients were reviewed (positive Finkelstein's maneuver). RESULTS US findings included tendon thickening and synovial sheath thickening with peritendinous edematous changes resulting in a peritendinous hypoecoic halo in all patients. An intertendinous septum was identified in two patients. CONCLUSION US can confirm the suspected diagnosis and provide follow-up of lesions. It can confirm the presence of an intertendinous septum and provide guidance at the time of steroid injection. It can increase the rate of conservative management by demonstrating the absence of septum.
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Affiliation(s)
- A N Diop
- Service de Radiologie/Imagerie Médicale, Hôpital Général de Grand-Yoff de Dakar, Sénégal.
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