This poster is published under an
open license. Please read the
disclaimer for further details.
Keywords:
Musculoskeletal soft tissue, Ultrasound, Puncture, Inflammation
Authors:
D. Orlandi1, G. Ferrero1, E. Fabbro1, G. Serafini2, E. Silvestri1, L. M. Sconfienza3; 1Genoa/IT, 2Pietra Ligure/IT, 3San Donato Milanese/IT
DOI:
10.1594/ecr2014/B-0048
Purpose
De Quervain's Disease
De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist,
caused by a thickening of the retinaculum.
This impairs the normal sliding of the abductor pollicis longus and the extensor pollicis brevis tendons.
The presence of an accessory tendon or a septum within the retinaculum may favour the occurrence of the disease.
Retinaculum thickening reflects chronic changes,
such as myxoid degeneration,
fibrocartilaginous metaplasia,
and mucopolysaccharide deposition.
De Quervain’s disease can be seen in 0.5% of males and 1.3% of females,
being frequently associated with pregnancy and nursing in the latter,
and has a considerable impact on daily activities.
Typical symptoms include pain or tenderness over the radial styloid,
sometimes radiating to the thumb and forearm.
Ulnar-side deviation with thumb grasped (Finkelstein’s test) is typically painful.
Retinaculum thickening and hypervascularity in the extensor compartment can be seen on ultrasound and power Doppler.
Conservative treatment may imply rest of the thumb and wrist,
with or without splinting.
Intracompartmental injections can provide complete relief of symptoms.
Studies about ultrasound-guided injections to treat de Quervain’s disease reported pain relief in 93.8% to 97% of patients at 6 months follow-up.
In recalcitrant cases,
surgery is required.
- Painful chronic stenosing tenosinovitis of the 1st extensor compartment of the wrist
- Fibrous thickening of the retinaculum
- Hypertrophy and effusion of tendon sheath
- Impingement and thickening of the APL and EPB
Fig. 2: Schematic draw of wrist compartments involved in De Quervain's disease
References: Michael E. Stadnick. 2004
Epidemiology
- 0.5% males,
1.3% females,
- V and VI decades
- Anatomic variants (vertical septum,
accessory tendons)
- Associated to pregnancy,
breastfeeding (baby wrist),
computer work
Fig. 3: Schematic draw (A) and US scan of a vertical septum (arrow) between extensor pollicis brevis (EPB) and abductor pollicis longus (APL).
Findings
- Functional limitation
- Pain
- Finkelstein’s test: thumb flexed and fist clenched over the thumb followed by ulnar deviation
Fig. 4: Finkelstein's Test
Imaging
- Diagnosis is established clinically
- MRI
- US
Fig. 5: Short axis (A) and long axis (B) US scan of the first dorsal compartment of the wrist showing marked retinaculum thickening (asterisks).
Fig. 6: Short axis US scan along the first dorsal compartment of the wrist in a patient affected by De Quervain's disease.
Fig. 7: Color Doppler shows high vascularity along the retinaculum.
Treatment
- Ice
- NSAIDs
- Rest,
splinting
- Surgery
- Injections (6-month recurrence = 20%)
The purpose of the current work is to compare the efficacy and the outcome at 6-month follow-up of three different US-guided treatment options for De Quervain’s disease.