Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease

Abstract

Objective

The aim of this study was to describe the technique and usefulness of ultrasound-guided intrasynovial injection of triamcinolone and bupivacaine in treatment of de Quervain′s disease.

Materials and methods

A total of 17 patients with symptomatic De Quervain′s disease were included in this study. The procedure involved confirmation of diagnosis with ultrasound followed by guided injection of a mixture of 20 mg of triamcinolone (40 mg/ml) and 1 ml of 0.5% bupivacaine. Ultrasound guidance with a high resolution 15-Mhz footprint probe was used for injection into the first dorsal extensor compartment tendon sheath (E1). The response to ultrasound-guided injection was ascertained at the post procedure outpatient clinic appointment according to the follow-up clinic notes.

Results

There were 14 female and 3 male patients aged 29 to 74 years. Mean duration of symptoms was 8.9 months. One patient had an atypical septum in the first extensor compartment and the extensor pollicis brevis alone was involved. The mean post-injection follow-up was at 6.75 weeks. One patient was lost to follow-up. Fifteen out of 16 patients had significant symptomatic relief (93.75%). There were no immediate or delayed complications. Recurrence of symptoms was seen in 3 (20%) patients.

Conclusion

Ultrasound-guided injection of triamcinolone and bupivacaine is safe and useful in controlling symptoms of De Quervain′s disease. Correct needle placement with ultrasound guidance avoids intratendinous injection as well as local complications like fat atrophy and depigmentation.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Piligian G, Herbert R, Hearns M, Dropkin J, Landsbergis P, Cherniack M. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med. 2000;37(1):75–93.

    CAS  Article  Google Scholar 

  2. 2.

    Sawaizumi T, Nanno M, Ito H. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31(2):265–8.

    Article  Google Scholar 

  3. 3.

    Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain's disease. Clin Anat. 2000;13(3):195–8.

    CAS  Article  Google Scholar 

  4. 4.

    Hart DA, Frank CB, Bray RC. Inflammatory processes in repetitive motion and overuse syndromes: potential role of neurogenic mechanisms in tendons and ligaments. In: Gordon SL, Blair SJ, Fine LJ, editors. Repetitive motion disorders of the upper extremity. Rosemont, IL: AAOS; 1995. p. 247–62.

    Google Scholar 

  5. 5.

    Trentanni C, Galli A, Melucci G, Stasi G. Ultrasonic diagnosis of De Quervain's stenosing tenosynovitis. Radiol Med. 1997;93(3):194–8.

    CAS  PubMed  Google Scholar 

  6. 6.

    Nishijo K, Kotani H, Miki T, Senzoku F, Ueo T. Unusual course of the extensor pollicis longus tendon associated with tenosynovitis, presenting as de Quervain disease—a case report. Acta Orthop Scand. 2000;71(4):426–8.

    CAS  Article  Google Scholar 

  7. 7.

    Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and relief of De Quervain’s tendinitis. J Hand Surg [Am]. 1998;23(1):89–96.

    CAS  Article  Google Scholar 

  8. 8.

    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(5):840–3.

    CAS  Article  Google Scholar 

  9. 9.

    Bakhach J, Sentucq-Rigal J, Mouton P, Boileau R, Panconi B, Guimberteau JC. The Omega “Omega” pulley plasty: a new technique for the surgical management of the De Quervain′s disease. Ann Chir Plast Esthet. 2006;51(1):67–73.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge Dr Ravi Marudanayagam and the department of Medical Illustration, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, for their help with Figs. 6 and 7.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Surabhi Choudhary.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jeyapalan, K., Choudhary, S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease. Skeletal Radiol 38, 1099–1103 (2009). https://doi.org/10.1007/s00256-009-0721-y

Download citation

Keywords

  • De Quervain′s tenosynovitis
  • Ultrasound
  • Steroid injection