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Ultrasound-guided Injections for de Quervain’s Tenosynovitis

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Nonsurgical management of de Quervain’s tenosynovitis often includes corticosteroid injections. If the injection does not enter the compartment, or all subcompartments, response to the injection is variable. To ensure proper location of injections we evaluated the role of ultrasound.

Questions/Purposes

We determined (1) the incidence of two or more subcompartments, (2) the incidence of anatomic variations during surgical release after failed injections, and (3) the relief of pain after ultrasound-guided injections.

Patients and Methods

A prospective series of 40 consecutive patients (42 wrists) diagnosed with de Quervain’s tenosynovitis by clinical examination were referred to a radiologist for an ultrasound-guided injection. The radiologist injected the first dorsal compartment and noted any septations. Patients returned for followup where outcomes, DASH, and VAS scores were calculated. The treating surgeon was blinded to any anatomic variations. Followup was at 6 weeks and a minimum of 6 months (mean, 6 weeks, range, 3–17 months; mean, 11 months, range, 7–18 months). Four patients were lost to followup.

Results

Multiple subcompartments were noted in 22 of 42 (52%) wrists. At the 6-week followup, 36 of the 37 wrists examined in 36 patients (97%) had at least partial resolution of symptoms. Multiple subcompartments were identified in 52% of cases. At last followup, the mean DASH and VAS scores were 18.4 and 2.2, respectively. However 14% of wrists had recurrence of symptoms, all of which had subcompartments on ultrasound. No adverse effects from the injections were noted.

Conclusion

We found ultrasound-guided injections to be useful for treatment of de Quervain’s tenosynovitis. Our success with ultrasound-guided injections was slightly better than that reported in the literature and without adverse reactions.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Alemohammad AM, Yazaki N, Morris RP, Buford WL, Viegas SF. Thumb interphalangeal joint extension by the extensor pollicis brevis: association with a subcompartment and de Quervain’s disease. J Hand Surg Am. 2009;34:719–723.

    Article  PubMed  Google Scholar 

  2. Anderson BC, Manthey R, Brouns MC. Treatment of de Quervain’s tenosynovitis with corticosteroids: a prospective study of the response to local injection. Arthritis Rheum. 1991;34:793–798.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  4. Chaffee A, Yakuboff M, Tanabe T. Responsiveness of the VAS and McGill pain questionnaire in measuring changes in musculoskeletal pain. J Sport Rehabil. 2011;20:250–255.

    PubMed  Google Scholar 

  5. Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop Belle Mead NJ. 1997;26:641–644.

    Google Scholar 

  6. Finkelstein H. Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg Am. 1930;12:509–540.

    Google Scholar 

  7. Giles KW. Anatomical variations affecting the surgery of de Quervain’s disease. J Bone Joint Surg Br. 1960;42:352–355.

    PubMed  Google Scholar 

  8. Gonzalez MH, Sohlberg R, Brown A, Weinzweig N. The first dorsal extensor compartment: an anatomic study. J Hand Surg Am. 1995;20:657–660.

    Article  PubMed  CAS  Google Scholar 

  9. Gousheh J, Yavari M, Arasteh E. Division of the first dorsal compartment of the hand into two separate canals: rule or exception? Arch Iran Med. 2009;12:52–54.

    PubMed  Google Scholar 

  10. Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990;15:83–87.

    Article  PubMed  CAS  Google Scholar 

  11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  PubMed  CAS  Google Scholar 

  12. Ilyas AM, Ast M, Schaffer AA, Thoder J. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15:757–764.

    PubMed  Google Scholar 

  13. 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.

    PubMed  CAS  Google Scholar 

  14. Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of De Quervain’s disease. Skeletal Radiol. 2009;38:1099–1103.

    Article  PubMed  Google Scholar 

  15. Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S. Treatment of de Quervain disease with triamcinolone injection with or without nimesulide: a randomized, double-blind, placebo controlled trial. J Bone Joint Surg Am. 2004;86:2700–2706.

    PubMed  Google Scholar 

  16. Keon-Cohen B. De Quervain’s disease. J Bone Joint Surg Br. 1951;33:96–99.

    PubMed  Google Scholar 

  17. Kwon BC, Choi SJ, Koh SH, Shin DJ, Baek GH. Sonographic identification of the intracompartmental septum in de Quervain’s disease. Clin Orthop Relat Res. 2010;468:2129–2134.

    Article  PubMed  Google Scholar 

  18. Lane LB, Boretz RS, Stuchin SA. Treatment of de Quervain’s disease: role of conservative management. J Hand Surg Br. 2001;26:258–260.

    Article  PubMed  CAS  Google Scholar 

  19. Leao L. De Quervain’s disease: a clinical and anatomical study. J Bone Joint Surg Am. 1958,40:1063–1070.

    Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. Loomis LK. Variations of stenosing tenosynovitis at the radial styloid process. J Bone Joint Surg Am. 1951;33:340–346.

    PubMed  Google Scholar 

  22. 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;13:195–198.

    Article  PubMed  CAS  Google Scholar 

  23. McKenzie JM. Conservative treatment of de Quervain’s disease. Br Med J. 1972;4:659–660.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    PubMed  CAS  Google Scholar 

  25. Mirzanli C, Ozturk K, Esenyel CZ, Ayanoglu S, Imren Y, Aliustaoglu S. Accuracy of intrasheath injection techniques for de Quervain’s disease: a cadaveric study. J Hand Surg Eur Vol. 2012;37:155–160.

    Article  PubMed  CAS  Google Scholar 

  26. Nagaoka M, Matsuzaki H, Suzuki T. Ultrasonographic examination of de Quervain’s disease. J Orthop Sci. 2000;5:96–99.

    Article  PubMed  CAS  Google Scholar 

  27. Nayak RS, Hussein M, Krishnamurthy A, Mansur DI, Prabhu LV, D’Souza P, Potu BK, Chettiar GK. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J. 2009;32:600–604.

    PubMed  Google Scholar 

  28. Opreanu RC, Wechter J, Tabbaa H, Kepros JP, Baulch M, Xie Y, Lackey W, Katranji A. Anatomic variations of the first extensor compartment and abductor pollicis longus tendon in trapeziometacarpal arthritis. Hand (NY). 2010;5:184–189.

    Article  Google Scholar 

  29. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B. Randomised controlled trial of local corticosteroid injections for de Quervain’s tenosynovitis in general practice. BMC Musculoskelet Disord. 2009;10:131.

    Article  PubMed  Google Scholar 

  30. Richie CA 3rd, Briner WW Jr. Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16:102–106.

    Article  PubMed  Google Scholar 

  31. Sawaizumi T, Nanno M, Ito H. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31:265–268.

    Article  PubMed  Google Scholar 

  32. Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain’s disease. J Hand Surg Am. 1994;19:595–598.

    Article  PubMed  CAS  Google Scholar 

  33. 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.

    PubMed  CAS  Google Scholar 

  34. Visuthikosol V, Chanyasawat S. Surgical treatment of de Quervain’s diseases: a clinical review of 42 cases. J Med Assoc Thai. 1988;71:637–639.

    PubMed  CAS  Google Scholar 

  35. 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. 2010;69:938–939.

    Article  PubMed  CAS  Google Scholar 

  36. 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.

    Article  PubMed  CAS  Google Scholar 

  37. 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.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA, 19107, USA

    James D. McDermott MD, Asif M. Ilyas MD & Charles F. Leinberry MD

  2. Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA

    Levon N. Nazarian MD

Authors
  1. James D. McDermott MD
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  2. Asif M. Ilyas MD
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  3. Levon N. Nazarian MD
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  4. Charles F. Leinberry MD
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Correspondence to Asif M. Ilyas MD.

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McDermott, J.D., Ilyas, A.M., Nazarian, L.N. et al. Ultrasound-guided Injections for de Quervain’s Tenosynovitis. Clin Orthop Relat Res 470, 1925–1931 (2012). https://doi.org/10.1007/s11999-012-2369-5

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  • DOI: https://doi.org/10.1007/s11999-012-2369-5

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