Top

Clinical Orthopaedics and Related Research®

Published in:

01-07-2012 | Clinical Research

Ultrasound-guided Injections for de Quervain’s Tenosynovitis

Authors: James D. McDermott, MD, Asif M. Ilyas, MD, Levon N. Nazarian, MD, Charles F. Leinberry, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2012

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.

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.PubMedCrossRef

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.PubMedCrossRef

Bahm J, Szabo Z, Foucher G. The anatomy of De Quervain’s disease: a study of operative findings. Int Orthop. 1995;19:209–211.PubMedCrossRef

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

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.

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

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

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

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

10.

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

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.PubMedCrossRef

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

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

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.PubMedCrossRef

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

16.

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

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.PubMedCrossRef

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.PubMedCrossRef

19.

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

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.PubMedCrossRef

21.

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

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.PubMedCrossRef

23.

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

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

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.PubMedCrossRef

26.

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

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

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.CrossRef

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.PubMedCrossRef

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.PubMedCrossRef

31.

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

32.

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

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

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

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

Title: Ultrasound-guided Injections for de Quervain’s Tenosynovitis
Authors: James D. McDermott, MD
Asif M. Ilyas, MD
Levon N. Nazarian, MD
Charles F. Leinberry, MD
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2369-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ultrasound-guided Injections for de Quervain’s Tenosynovitis

Abstract

Background

Questions/Purposes

Patients and Methods

Results

Conclusion

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/Purposes

Patients and Methods

Results

Conclusion

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 7/2012

Poor Survival for Osteosarcoma of the Pelvis: A Report from the Children’s Oncology Group

Complications in Brief: Meniscus Repair

Gamma-irradiation Sterilization in an Inert Environment: A Partial Solution

Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

Surgical Treatment of Neer Group VI Proximal Humeral Fractures: Retrospective Comparison of PHILOS® and Hemiarthroplasty

Reply to Letter to the Editor: Increased Anteversion of Press-Fit Femoral Stems Compared with Anatomic Femur