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He KS, He KS, Cheah A, Al‐Halabi B, Danino MA, Efanov JI. Unblinding de Quervain: A systematic review of ultrasound-guided injection of corticosteroids for treatment of stenosing tenosynovitis of the 1st extensor compartment. J Med Radiat Sci 2023; 70:319-326. [PMID: 37078429 PMCID: PMC10500109 DOI: 10.1002/jmrs.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
A systematic review was conducted on studies reporting steroid injections with ultrasound for de Quervain. From 10 studies included and 379 wrists, 73.9% reported complete resolution of symptoms, 18.2% with partial and 7.9% without resolution. When compared to the landmark-guided technique, ultrasound guidance showed significantly higher rates of symptom resolution (P = 0.0132) and lower pain scores (P < 0.0001). Twenty-nine patients out of 163 who initially showed complete resolution of symptoms reported subsequent recurrence. We conclude that steroid injections guided by ultrasound present high rates of symptomatic relief through precise needle insertion, especially in cases of anatomic variability with subcompartments.
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Affiliation(s)
- Kathy Shiqi He
- Plastic and Reconstructive SurgeryCentre hospitalier de l'Université de Montréal (CHUM)MontrealQuebecCanada
| | - Kevin Shixiao He
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Andre Cheah
- Hand and Reconstructive MicrosurgeryNational University Hospital (NUH)SingaporeSingapore
| | - Becher Al‐Halabi
- Plastic and Reconstructive SurgeryCentre hospitalier de l'Université de Montréal (CHUM)MontrealQuebecCanada
| | - Michel Alain Danino
- Plastic and Reconstructive SurgeryCentre hospitalier de l'Université de Montréal (CHUM)MontrealQuebecCanada
| | - Johnny Ionut Efanov
- Plastic and Reconstructive SurgeryCentre hospitalier de l'Université de Montréal (CHUM)MontrealQuebecCanada
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Morisaki S, Tsuchida S, Oda R, Takahashi K. Quantitative Analysis of Ultrasonography for de Quervain's Disease: Comparison of the Affected Side With the Asymptomatic Side. J Ultrasound Med 2023; 42:1437-1443. [PMID: 36514245 DOI: 10.1002/jum.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The pathology of de Quervain's disease affects the tenosynovium and rarely the tendons. The ultrasonographic features of de Quervain's disease unresponsive to conservative treatment are unknown. The purpose of this study was to describe and compare the morphological differences between patients with de Quervain's disease that is refractory to conservative treatment and patients who respond to conservative treatment. METHODS de Quervain's disease unresponsive to conservative treatment was evaluated in 51 patients. The bilateral wrists underwent preoperative ultrasonographic assessments. The asymptomatic side was presumed to be the patient's anatomical baseline and was used for comparison. We measured the diameter and cross-sectional area of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), and the thickness of the tendon sheath and the intercompartmental septum, if present. The affected side and asymptomatic side were compared. RESULTS The APL and EPB cross-sectional area was significantly larger on the affected side than on the asymptomatic side (APL: 13 mm2 versus 8.3 mm2 ; P < .0001; EPB: 5.4 mm2 versus 3.9 mm2 ; P = .031). The tendon sheath was significantly thicker on the affected side (1.5 mm) than on the asymptomatic side (0.95 mm) (P < .0001). The intercompartmental septum was significantly thicker on the affected side (1.1 mm) than on the asymptomatic side (0.72 mm) (P = .0004). Operative findings revealed 41 (80%) patients had an intercompartmental septum. CONCLUSIONS The ultrasonographic features of de Quervain's disease requiring surgical treatment were a significantly thickened tendon sheath, an intercompartmental septum, and increased cross-sectional area of the APL and EPB.
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Affiliation(s)
| | - Shinji Tsuchida
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023; 107:105-114. [PMID: 35195844 PMCID: PMC10020267 DOI: 10.1007/s12306-022-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.
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Affiliation(s)
| | | | - A M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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Beidleman MB, Colberg RE, Beason DP, Fleisig GS. A Retrospective Case Series Study on a Minimally Invasive Ultrasound-Guided First Dorsal Compartment Release Technique for Refractory De Quervain Tenosynovitis. Am J Phys Med Rehabil 2023; 102:235-240. [PMID: 35944081 DOI: 10.1097/phm.0000000000002082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of patients treated with a novel minimally invasive complete release of the first dorsal compartment percutaneously under ultrasound guidance using an 18-gauge needle with an 18 blade at the tip. DESIGN This was a retrospective case series. Nine adults (ten wrists) were included in the study of this technique. All patients had failed conservative care and had tenderness to palpation over the first dorsal compartment, a positive Finklestein test, and confirmed tenosynovitis with ultrasound imaging before the procedure. The main outcome measures were reduction in pain as determined by the numeric rating scale and improvement of function determined by the Nirschl Phase scale at both short- and long-term follow-up. RESULTS There was 100% follow-up, with mean (SD) follow-up occurring at 23.1 (9.8) mos (range, 9-42 mos). From preprocedure to follow-up, numeric rating scale pain decreased from 4.1 (SD, 2.5) to 0.0 (SD, 0.0) ( P < 0.001), and Nirschl phase improved from 2.5 (SD, 1.9) to 0.2 (SD, 0.4) ( P = 0.03). No patients required revision open-release surgery or suffered neurovascular complications. CONCLUSION This technique resulted in significant improvement of pain and function for all patients and no short- or long-term neurovascular complications were seen.
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Jung HS, Baek SH, Lee JS. Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial. Clin Orthop Relat Res 2022; 480:762-770. [PMID: 34694249 PMCID: PMC8923580 DOI: 10.1097/corr.0000000000002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrasonography (US)-guided steroid injections can improve the accuracy of injection in patients with de Quervain disease, especially in those with an intracompartmental septum. Although the main lesion of de Quervain disease in patients with a septum is a stenosing tenosynovitis of the extensor pollicis brevis (EPB), no report we know of has compared injection into the EPB subcompartment with an injection into both the abductor pollicis longus (APL) and EPB subcompartments. In this randomized trial, we compared the results of US-guided steroid injections targeting both subcompartments and the EPB subcompartment alone in patients with de Quervain disease. QUESTIONS/PURPOSES (1) Do patients who receive a steroid injection in the EPB subcompartment alone have lower pain scores at 6 weeks and at 3 months after US-guided injection compared with patients who receive an injection in both subcompartments? (2) Do patients who receive a steroid injection in the EPB subcompartment alone experience fewer steroid injection-related complications than patients who receive an injection in both subcompartments? METHODS A randomized controlled study was performed at a single center between August 2018 and March 2021. Patients with a diagnosis of de Quervain disease and with a complete intracompartmental septum between the APL and the EPB tendons were included. In total, 112 patients had a diagnosis of de Quervain disease during the study period. Definite, complete subcompartmentalization was seen in 50 patients. Patients were randomly assigned to US-guided injections targeting both subcompartments (n = 25) or the EPB subcompartment alone (n = 25). There were no between-group differences in age, gender, affected wrist, or disease duration, and all patients had US evidence of tendinosis of the EPB, with or without tendinosis of the APL. Although 33% of patients (16 of 48) showed tendinosis of the APL, no patient showed tendinosis of the APL alone. In all patients, a dorsal-to-palmar side injection of 0.5 mL of 2% lidocaine and 0.5 mL of triamcinolone acetonide (40 mg/mL) was administered by two experienced hand surgeons. In the both-subcompartments group, US-guided injections were performed in each of the APL and EPB subcompartments. In the EPB subcompartment group, US-guided injections were administered in the EPB subcompartment only. All patients underwent the same protocol after the procedure. Four percent (n = 2, 1 in each group) of patients were excluded after randomization because their pain level was not registered. Pre- and postinjection clinical outcome assessments were completed by orthopaedic surgery residents not involved in patient management. Patients were regularly examined at baseline, 6 weeks, and 3 months to evaluate the intensity of pain. We assessed pain by the VAS score, where 0 indicated no pain and 100 the most pain. At baseline, the VAS score was 67 ± 14 in the both-subcompartment group and 67 ± 16 in the EPB subcompartment group (mean difference 0.17 [95% CI -8.45 to 8.82]; p = 0.97). Complications related to the steroid injection, including numbness, tendon rupture, and skin hypopigmentation, were also recorded at final follow-up examinations. To determine statistical power, the VAS score for pain at 6 weeks after the injection was used as the primary outcome variable. The minimum clinically important difference for the VAS score was deemed to be 20 mm, and we estimated an SD of 23. A sample size calculation indicated that a sample of 21 patients per group would provide 80% power to detect an effect of this size between the groups at the p = 0.05 level using a t-test. RESULTS There were no differences in the VAS scores between the both-subcompartment group and the EPB group at 6 weeks (10 ± 6 versus 10 ± 7, mean difference -0.08 [95% CI -4.08 to 3.91]; p = 0.97). The same was true at 12 weeks (12 ± 13 versus 11 ± 15, mean difference 0.38 [95% CI -7.74 to 8.49]; p = 0.09). No adverse events related to treatment (such as tendon rupture, infections, and numbness) occurred in either group. However, skin hypopigmentation occurred at the final follow-up examination in both groups. The proportion of patients experiencing skin hypopigmentation in the EPB subcompartment group was lower than in the both-subcompartment group (33% [8 of 24] versus 67% [16 of 24]; odds ratio 0.25 [95% CI 0.08 to 0.83]; p = 0.02). CONCLUSION Our data suggest that a US-guided steroid injection targeting the EPB subcompartment alone is as effective in terms of pain reduction as targeting both subcompartments in patients with de Quervain disease who have complete septation. Furthermore, an injection targeting the EPB subcompartment alone can reduce the dose of steroids used, perhaps thereby decreasing complications related to steroid injections. We recommend using only single-compartment injections in this context, even among patients with an intracompartmental septum. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Suk Ho Baek
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Jae Sung Lee
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
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Uemura T, Yano K, Miyashima Y, Konishi S, Nakamura H. Posttraumatic triggering of the extensor pollicis brevis tendon in de Quervain's disease successfully diagnosed with ultrasonography: A case report. J Clin Ultrasound 2021; 49:398-400. [PMID: 33022111 DOI: 10.1002/jcu.22934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Triggering due to de Quervain's disease is exceedingly rare. This is the first successfully diagnosed case of the snapping phenomenon of the extensor pollicis brevis (EPB) tendon in de Quervain's disease evaluated with preoperative dynamic ultrasonography, clearly demonstrated in an intraoperative video, and treated with decompression of EPB subcompartment only under a wide-awake surgery. Dynamic ultrasonographic images identified snapping caused by unsmooth excursion of an enlarged EPB tendon in a separate subcompartment. In snapping de Quervain's disease, ultrasonographic evaluations and wide-awake surgery are essential to exactly diagnose and successfully treat the snapping condition of the EPB and/or APL tendons.
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Affiliation(s)
- Takuya Uemura
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan
| | - Yusuke Miyashima
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Kim SJ, Lee CH, Khil EK, Choi JA, Im WY, Lee KH. Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon. J Ultrasound Med 2020; 39:1553-1560. [PMID: 32045018 DOI: 10.1002/jum.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We performed preoperative ultrasonography (US) to detect the anatomic course of the superficial radial nerve (SRN) and dominant pathologic tendon of the first extensor compartment in de Quervain tenosynovitis. METHODS We prospectively studied 27 patients (29 wrists) with de Quervain tenosynovitis who underwent surgical release of the first extensor compartment. Preoperatively, US was performed to evaluate the presence of the dominant pathologic tendon and the septum in the subcompartment, number of SRNs in the area of the surgical incision, and anatomic running course of the SRN. These variables were also checked intraoperatively. Cohen κ statistics were calculated to investigate agreement between US and surgical field findings. RESULTS There were 7 men and 20 women (mean age, 47.8 years; range, 26-67 years). For the dominant pathologic tendon, there were 2 cases (6.9%) of an abductor pollicis longus, 11 cases (37.9%) of an extensor pollicis brevis, and 16 cases (55.2 %) of a nondominant tendon (κ = 0.94). For the subcompartment, there were 10 cases (34.5%) without a septum, 8 (27.6%) with an incomplete septum, and 11 (37.9%) with a complete septum (κ = 0.95). Most SRNs crossed over the first extensor compartment (κ = 0.78). CONCLUSIONS Preoperative US can be useful in detecting the anatomic running course of the SRN and dominant pathologic tendon before surgery for de Quervain tenosynovitis. Classifying the anatomic course of the SRN could be essential to planning surgery, and it could be helpful to prevent injury of the SRN during surgery.
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Affiliation(s)
- Sung-Jae Kim
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Woo-Young Im
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Kwang-Hyun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
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Abstract
We aimed to determine whether dorsoulnar incision elevating radial flap and immobilization for the treatment of de Quervain disease have an advantage over simple midline incision and early mobilization, respectively, in terms of tendon subluxation and clinical outcomes. Forty-six patients with de Quervain disease were randomly divided into 2 groups (midline incision vs dorsoulnar incision) and 2 subgroups (immobilization vs early mobilization). Subluxation of intracompartmental tendons was measured in dynamic wrist positions at 12 and 24 weeks using ultrasonography. The DASH (Disabilities of the Arm, Shoulder, and Hand) and visual analog scale scores and grip and pinch strengths were evaluated. At 24 weeks, the tendons were displaced voloradially in wrist volar flexion (1.25 mm in midline incision vs 0.36 mm in dorsoulnar incision, P = 0.001), whereas the tendons were displaced dorsoulnarly in wrist extension (0.95 mm in midline incision vs 1.78 mm in dorsoulnar incision, P = 0.041). There were no significant differences in tendon displacement between early mobilization and immobilization groups. Clinical outcome measures showed no variation between the groups, and no significant correlation occurred with tendon subluxation. Dorsoulnar incision and postoperative immobilization do not have advantage over midline incision and early mobilization, respectively. However, tendon subluxation after release of the first dorsal compartment for de Quervain disease does not affect clinical outcomes.
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Affiliation(s)
- Ji-Hyo Kim
- From the Department of Career Education, College of General Education
| | - Seog-Won Yang
- Department of Orthopedic Surgery, College of Medicine, and
| | - Hee-Jeong Ham
- Department of Orthopedic Surgery, College of Medicine, and
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Colberg RE, Henderson RG. Ultrasound-Guided First Dorsal Compartment Release for Refractory de Quervain Tenosynovitis: A Case Report. PM R 2019; 11:665-668. [PMID: 30609241 DOI: 10.1002/pmrj.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 12/02/2018] [Indexed: 11/07/2022]
Abstract
De Quervain tenosynovitis is an overuse syndrome associated with inflammation of the tendons in the first dorsal compartment of the wrist. Management includes activity modification, splinting, and corticosteroid injections. In refractory cases, surgical release may be performed, which may be complicated by incomplete release, tendon subluxation, or radial nerve injury. Alternatively, ultrasound-guided release may improve patient satisfaction and outcomes through faster recovery time as well as improved visualization of subcompartments and neurovascular structures. To the best of the authors' knowledge, this is the first case in the literature describing a novel technique for ultrasound-guided first dorsal compartment release for refractory de Quervain tenosynovitis.
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Affiliation(s)
- Ricardo E Colberg
- Non-surgical Sports Medicine Division, Andrews Sports Medicine and Orthopedic Center, Andrews Sports Medicine Institute, Birmingham, AL
| | - Rachel G Henderson
- Non-surgical Sports Medicine Division, Andrews Sports Medicine and Orthopedic Center, Andrews Sports Medicine Institute, Birmingham, AL
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sato J, Ishii Y, Noguchi H. Ultrasonographic Evaluation of the Prevalence of an Intracompartmental Septum in Patients With de Quervain's Disease. Orthopedics 2016; 39:112-6. [PMID: 26913767 DOI: 10.3928/01477447-20160222-05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/07/2015] [Indexed: 02/03/2023]
Abstract
It has been reported that more patients with de Quervain's disease who had undergone surgical treatment had a septated dorsal compartment than did normal cadavers. The purpose of this study was to sonographically evaluate the prevalence of an intracompartmental septum in patients with de Quervain's disease and to compare the prevalence between groups categorized by sex, age, and peripartum status. The authors performed an ultrasonographic examination of 112 wrists from 103 patients with de Quervain's disease. The prevalence of a septum-like structure in the first compartment was compared between men and women, between older (≥40 years) and younger (≤39 years) patients, and between pregnant or lactating women and other patients. The prevalence of intracompartmental septum in patients with de Quervain's disease was 61.6% (69 of 112). Of the 69 wrists with an intracompartmental septum-like structure, 53 showed this structure completely through the level of the radial styloid, and 16 showed it partially on the level of the distal radial styloid. There was no significant difference between any 2 groups categorized by the patients' demographics. The prevalence of intracompartmental septation in the patients with de Quervain's disease was higher than the previously reported prevalence in cadavers and lower than that of patients who underwent surgery. This result was consistent with a previous report that patients with a septated dorsal compartment may be more at risk of contracting de Quervain's disease and more prone to failure of nonoperative treatment.
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Sivan M, Brown J, Brennan S, Bhakta B. A one-stop approach to the management of soft tissue and degenerative musculoskeletal conditions using clinic-based ultrasonography. Musculoskeletal Care 2011; 9:63-68. [PMID: 21618397 DOI: 10.1002/msc.194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE One-stop clinics aim at assessment, investigation and initiating treatment in a single hospital visit. They have been proven to be cost-effective and to increase patient satisfaction in various specialties. The aim of this study was to describe the one-stop approach to managing soft tissue and degenerative musculoskeletal conditions using clinic-based musculoskeletal ultrasonography (MSUS). METHODS A retrospective case record review was carried out of patients assessed and managed in the musculoskeletal clinic by a musculoskeletal and sports physician over a 10-month period. RESULTS A total of 1,166 patients were assessed and managed in a total of 155 outpatient clinics. The age range of patients was 19 to 85 years (median age 45 years). The diagnoses included traumatic or overuse tendinopathy, degenerative arthritis, bursitis, acute/chronic sporting injuries and acute/chronic back pain. A total of 1,012 patients (87%) had conditions related to the appendicular system (shoulder girdle, upper limb, pelvic girdle and lower limb) and 154 patients were referred with spinal pain. All patients with appendicular system problems had a definite diagnosis and treatment initiated on the first visit to the clinic. In 658 (65%) patients, a diagnostic ultrasound was deemed an appropriate investigation to improve the accuracy of diagnosis and more than half of them (352 patients) needed ultrasound-guided injections as part of the management of their conditions. A portable GE Healthcare LOGIQe machine with a 10 MHz linear probe and colour Doppler flow imaging was used to perform all scans. No adverse incidents were reported. CONCLUSIONS The use of clinic-based MSUS enables a one-stop approach, reduces repeated hospital appointments and improves quality of care in an outpatient musculoskeletal clinic.
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Affiliation(s)
- Manoj Sivan
- Department of Rehabilitation Medicine, Chapel Allerton Hospital, Leeds, UK.
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Volpe A, Pavoni M, Marchetta A, Caramaschi P, Biasi D, Zorzi C, Arcaro G, Grassi W. Ultrasound differentiation of two types of de Quervain's disease: the role of retinaculum. Ann Rheum Dis 2009; 69:938-9. [PMID: 19900935 DOI: 10.1136/ard.2009.123026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med 2009; 28:779-786. [PMID: 19470818 DOI: 10.7863/jum.2009.28.6.779] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications. METHODS Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens. RESULTS The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens. CONCLUSIONS Sonography is able to depict and differentiate between these conditions.
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Affiliation(s)
- Michel De Maeseneer
- Department of Radiology, Wake Forest University Hospital, Medical Center Boulevard, Winston-Salem, NC 27157-1088, USA.
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Abstract
PURPOSE The purpose of this study is to describe the scintigraphic pattern of de Quervain tenosynovitis, a common inflammatory condition of the thumb tendon sheaths related to repetitive use. MATERIALS AND METHODS The author conducted a retrospective audit of consecutive cases with independent clinical validation of the final diagnosis. RESULTS There were 7 cases of clinically confirmed de Quervain tenosynovitis. The typical scintigraphic finding was a focal area of superficial linear hyperemia and skeletal uptake along the radial aspect of the distal radius corresponding to the anatomic location of the abductor pollicis longus and extensor pollicis brevis. All cases showed an abnormality on at least one phase of the bone scan. CONCLUSIONS Bone scanning appears to be of value in the differential diagnosis of dorsolateral wrist pain when clinical findings are nondiagnostic. The scintigraphic appearance of de Quervain tenosynovitis can help to confirm the diagnosis while excluding other causes of wrist pain. Determining the sensitivity and specificity of this pattern will require further research.
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Affiliation(s)
- William D Leslie
- Department of Nuclear Medicine, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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