Clinical Orthopaedics and Related Research®

, Volume 468, Issue 8, pp 2129–2134 | Cite as

Sonographic Identification of the Intracompartmental Septum in de Quervain’s Disease

  • Bong Cheol Kwon
  • Soo-Joong Choi
  • Sung Hye Koh
  • Dong Jo Shin
  • Goo Hyun Baek
Clinical Research Hand



The intracompartmental septum in the first extensor compartment in patients with de Quervain’s disease has been associated with disease development and prognosis. However, with the exception of surgical exploration, there is no way of detecting the septum.


We evaluated the accuracy of sonography for identifying the intracompartmental septum in the first extensor compartment in patients with de Quervain’s disease using surgical findings as the reference standard.

Patients and Methods

We performed surgical release of the first extensor compartment in 43 wrists of 40 patients who were unresponsive to nonoperative treatment. In each case, a sonographic evaluation was performed before surgery by a radiologist and the sonographic and surgical findings were compared.


Sonography identified the intracompartmental septum in 19 of the 19 septum-present wrists and absence of the septum in 23 of the 24 septum-absent wrists. The sensitivity of sonography was 100% (95% confidence interval, 80%–100%), its specificity 96% (95% confidence interval, 78%–100%), accuracy 98% (95% confidence interval, 87%–100%), positive predictive value 95% (95% confidence interval, 74%–100%), and negative predictive value 100% (95% confidence interval, 83%–100%). Sonography also identified septum-like structures in 15 of 37 (41%) asymptomatic contralateral wrists.


Sonography is useful for detecting the intracompartmental septum in the first extensor compartment in patients with de Quervain’s disease.

Level of Evidence

Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binominal proportions. Am Statist. 1998;52:119–126.CrossRefGoogle Scholar
  2. 2.
    Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain’s disease of pregnancy and lactation. J Hand Surg Am. 2002;27:322–324.CrossRefPubMedGoogle Scholar
  3. 3.
    Bahm J, Szabo Z, Foucher G. The anatomy of de Quervain’s disease: a study of operative findings. Int Orthop. 1995;19:209–211.CrossRefPubMedGoogle Scholar
  4. 4.
    Giles KW. Anatomical variations affecting the surgery of de Quervain’s disease. J Bone Joint Surg Br. 1960;42:352–355.PubMedGoogle Scholar
  5. 5.
    Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990;15:83–87.CrossRefPubMedGoogle Scholar
  6. 6.
    Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist: a clinical and anatomical study. J Bone Joint Surg Am. 1986;68:923–926.PubMedGoogle Scholar
  7. 7.
    Jayaraman S, Naidich TP. The carpal tunnel: ultrasound display of normal imaging anatomy and pathology. Neuroimaging Clin N Am. 2004;14:103–113, viii.Google Scholar
  8. 8.
    Keon-Cohen B. De Quervain’s disease. J Bone Joint Surg Br. 1951;33:96-99.PubMedGoogle Scholar
  9. 9.
    Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg. 2007;41:36–38.CrossRefPubMedGoogle Scholar
  10. 10.
    Leao L. De Quervain’s disease: a clinical and anatomical study. J Bone Joint Surg Am. 1958;40:1063–1070.PubMedGoogle Scholar
  11. 11.
    Leslie BM, Ericson WB Jr, Morehead JR. Incidence of a septum within the first dorsal compartment of the wrist. J Hand Surg Am. 1990;15:88–91.CrossRefPubMedGoogle Scholar
  12. 12.
    Louis DS. Incomplete release of the first dorsal compartment: a diagnostic test. J Hand Surg Am. 1987;12:87–88.PubMedGoogle Scholar
  13. 13.
    Minamikawa Y, Peimer CA, Cox WL, Sherwin FS. De Quervain’s syndrome: surgical and anatomical studies of the fibroosseous canal. Orthopedics. 1991;14:545–549.PubMedGoogle Scholar
  14. 14.
    Nagaoka M, Matsuzaki H, Suzuki T. Ultrasonographic examination of de Quervain’s disease. J Orthop Sci. 2000;5:96–99.CrossRefPubMedGoogle Scholar
  15. 15.
    Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, Imbernon E, Goldberg M. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum. 2006;55:765–778.CrossRefPubMedGoogle Scholar
  16. 16.
    Rossi C, Cellocco P, Margaritondo E, Bizzarri F, Costanzo G. De Quervain disease in volleyball players. Am J Sports Med. 2005;33:424–427.CrossRefPubMedGoogle Scholar
  17. 17.
    Ta KT, Eidelman D, Thomson JG. Patient satisfaction and outcomes of surgery for de Quervain’s tenosynovitis. J Hand Surg Am. 1999;24:1071–1077.CrossRefPubMedGoogle Scholar
  18. 18.
    Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain’s disease. J Hand Surg Am. 1994;19:595–598.CrossRefPubMedGoogle Scholar
  19. 19.
    Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis: a prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991;73:219–222.PubMedGoogle Scholar
  20. 20.
    Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain’s tenosynovitis in a young, active population. J Hand Surg Am. 2009;34:112–115.CrossRefPubMedGoogle Scholar
  21. 21.
    Yuasa K, Kiyoshige Y. Limited surgical treatment of de Quervain’s disease: decompression of only the extensor pollicis brevis subcompartment. J Hand Surg Am. 1998;23:840–843.CrossRefPubMedGoogle Scholar
  22. 22.
    Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain’s tendinitis. J Hand Surg Am. 1998;23:89–96.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Bong Cheol Kwon
    • 1
  • Soo-Joong Choi
    • 1
  • Sung Hye Koh
    • 2
  • Dong Jo Shin
    • 1
  • Goo Hyun Baek
    • 3
  1. 1.Department of Orthopedic SurgeryHallym University Sacred Heart HospitalAnyang-si Gyeonggi-doSouth Korea
  2. 2.Department of RadiologyHallym University Sacred Heart HospitalKyeonggidoSouth Korea
  3. 3.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations