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Nishimura Y, Tsutsumi M, Yamamoto R, Sakuraya T, Emura K, Arakawa T. Morphological differences between the dorsal and palmar septa of the first extensor compartment in relation to the brachioradialis and pronator quadratus. Ann Anat 2024; 253:152228. [PMID: 38340878 DOI: 10.1016/j.aanat.2024.152228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The first extensor compartment of the wrist is known as a frequent site of stenosing tenosynovitis, referred to as de Quervain's disease. De Quervain's disease occurs more frequently in the dorsal part of the first extensor compartment than in the palmar part; however, the anatomical reason why the dorsal part is worse remains poorly elucidated. This study clarified the morphological differences between the dorsal and palmar parts by examining their relationship with the surrounding structures. METHODS In this study, a total of 35 wrists from 23 Japanese cadavers were used. Twenty-five wrists were randomly assigned for macroscopic analysis, and the remaining 10 wrists were used for histological analysis. RESULTS The palmar septum of the first extensor compartment was connected to the brachioradialis tendon and superficial head of the pronator quadratus and was histologically stout compared to the dorsal septum. Despite several anatomical variations, such as the septum between the abductor pollicis longus/extensor pollicis brevis and the multiple tendons of these muscles, the aforementioned characteristics of the fibrous sheath in the first extensor compartment were identical in all specimens. CONCLUSION In contrast to the fragile structure of the dorsal septum, the stout structure of the palmar septum could be related to the low occurrence of symptoms of de Quervain's disease. The present results could play a role in revealing the pathogeny and establish the precise treatment for de Quervain's disease and provide an anatomical basis for kinesiological/biomechanical studies.
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Affiliation(s)
- Yuka Nishimura
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1 26-16 Nankokita, Suminoe-ku, Osaka 559-8611, Japan; Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rintaro Yamamoto
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tohma Sakuraya
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Anatomy, Division of Oral Structure, Function and Development, Asahi University School of Dentistry, Mizuho, Gifu, Japan
| | - Kenji Emura
- Faculty of Health Care Sciences, Himeji Dokkyo University, Himeji, Japan
| | - Takamitsu Arakawa
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.
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McBain B, Rio E, Cook J, Sanderson J, Docking S. Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial. HAND THERAPY 2023; 28:72-84. [PMID: 37904860 PMCID: PMC10584067 DOI: 10.1177/17589983231158499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/20/2023] [Indexed: 11/01/2023]
Abstract
Introduction de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Methods This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Results Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusions Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.
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Affiliation(s)
- Brodwen McBain
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- The Upper Limb Co, Melbourne, VIC, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | | | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
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Díaz HFS, Martínez MV, Fernández FD, Horcajadas ÁB, Luna AR, Iborra Á, Yubero MEC. Utilidad de la ecografía en la cirugía de la mano: Parte II. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1755585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ResumenEn los últimos años, con los avances técnicos en la ecografía, aumentó la calidad de las imágenes, lo que ha permitido a los cirujanos mejorar su capacidad de evaluar la mano y la muñeca. Las infiltraciones ecoguiadas en cirugía de mano son más precisas y seguras en comparación con las infiltraciones sin el uso de ecografía. El desarrollo de la técnica de ecografía y de transductores de alta resolución nos ayuda a realizar procedimientos ecoguiados, como el tratamiento del dedo en gatillo, la liberación del síndrome del túnel carpiano, y la aponeurotomía en la enfermedad de Dupuytren. El objetivo de este trabajo es describir las técnicas ecográficas en el tratamiento de las patologías de la mano y el estado del arte de las cirugías ecoguiadas de la mano y sus resultados.
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Affiliation(s)
- Homid Fahandezh-Saddi Díaz
- Clínica AVANFI y Unidad de Cirugía de Mano, Hospital Universitario Fundación, Alcorcón
- Unidad Cirugía Ecoguiada, Hospital Beata María Ana
| | | | | | - Ángel Bueno Horcajadas
- Especialista en Radiología Musculoesquelética en Hospital Universitario, Fundación Alcorcón
| | - Antonio Ríos Luna
- Cirugía Ortopédica y Traumatología, Clínica Doctor Antonio Ríos Luna, Almería
| | - Álvaro Iborra
- Unidad Cirugía Ecoguiada, Hospital Beata María Ana
- Especialista en Podología y Cirugía Ecoguiada, Clínica AVANFI
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Sugiura S, Matsuura Y, Suzuki T, Nishikawa S, Toyooka T, Ohtori S. Biomechanical assessment of the first dorsal compartment of the wrist: a fresh cadaver study with relevance to de Quervain's disease. Clin Anat 2022; 35:1058-1063. [DOI: 10.1002/ca.23872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shiro Sugiura
- Nishikawa Orthopaedic Clinic Chiba Japan
- Department of Bioenvironmental Medicine, Graduate School of Medicine Chiba University Chiba Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University Chiba Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine Chiba University Chiba Japan
| | | | | | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University Chiba Japan
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Jung HS, Baek SH, Lee JS. Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial. Clin Orthop Relat Res 2022; 480:762-770. [PMID: 34694249 PMCID: PMC8923580 DOI: 10.1097/corr.0000000000002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrasonography (US)-guided steroid injections can improve the accuracy of injection in patients with de Quervain disease, especially in those with an intracompartmental septum. Although the main lesion of de Quervain disease in patients with a septum is a stenosing tenosynovitis of the extensor pollicis brevis (EPB), no report we know of has compared injection into the EPB subcompartment with an injection into both the abductor pollicis longus (APL) and EPB subcompartments. In this randomized trial, we compared the results of US-guided steroid injections targeting both subcompartments and the EPB subcompartment alone in patients with de Quervain disease. QUESTIONS/PURPOSES (1) Do patients who receive a steroid injection in the EPB subcompartment alone have lower pain scores at 6 weeks and at 3 months after US-guided injection compared with patients who receive an injection in both subcompartments? (2) Do patients who receive a steroid injection in the EPB subcompartment alone experience fewer steroid injection-related complications than patients who receive an injection in both subcompartments? METHODS A randomized controlled study was performed at a single center between August 2018 and March 2021. Patients with a diagnosis of de Quervain disease and with a complete intracompartmental septum between the APL and the EPB tendons were included. In total, 112 patients had a diagnosis of de Quervain disease during the study period. Definite, complete subcompartmentalization was seen in 50 patients. Patients were randomly assigned to US-guided injections targeting both subcompartments (n = 25) or the EPB subcompartment alone (n = 25). There were no between-group differences in age, gender, affected wrist, or disease duration, and all patients had US evidence of tendinosis of the EPB, with or without tendinosis of the APL. Although 33% of patients (16 of 48) showed tendinosis of the APL, no patient showed tendinosis of the APL alone. In all patients, a dorsal-to-palmar side injection of 0.5 mL of 2% lidocaine and 0.5 mL of triamcinolone acetonide (40 mg/mL) was administered by two experienced hand surgeons. In the both-subcompartments group, US-guided injections were performed in each of the APL and EPB subcompartments. In the EPB subcompartment group, US-guided injections were administered in the EPB subcompartment only. All patients underwent the same protocol after the procedure. Four percent (n = 2, 1 in each group) of patients were excluded after randomization because their pain level was not registered. Pre- and postinjection clinical outcome assessments were completed by orthopaedic surgery residents not involved in patient management. Patients were regularly examined at baseline, 6 weeks, and 3 months to evaluate the intensity of pain. We assessed pain by the VAS score, where 0 indicated no pain and 100 the most pain. At baseline, the VAS score was 67 ± 14 in the both-subcompartment group and 67 ± 16 in the EPB subcompartment group (mean difference 0.17 [95% CI -8.45 to 8.82]; p = 0.97). Complications related to the steroid injection, including numbness, tendon rupture, and skin hypopigmentation, were also recorded at final follow-up examinations. To determine statistical power, the VAS score for pain at 6 weeks after the injection was used as the primary outcome variable. The minimum clinically important difference for the VAS score was deemed to be 20 mm, and we estimated an SD of 23. A sample size calculation indicated that a sample of 21 patients per group would provide 80% power to detect an effect of this size between the groups at the p = 0.05 level using a t-test. RESULTS There were no differences in the VAS scores between the both-subcompartment group and the EPB group at 6 weeks (10 ± 6 versus 10 ± 7, mean difference -0.08 [95% CI -4.08 to 3.91]; p = 0.97). The same was true at 12 weeks (12 ± 13 versus 11 ± 15, mean difference 0.38 [95% CI -7.74 to 8.49]; p = 0.09). No adverse events related to treatment (such as tendon rupture, infections, and numbness) occurred in either group. However, skin hypopigmentation occurred at the final follow-up examination in both groups. The proportion of patients experiencing skin hypopigmentation in the EPB subcompartment group was lower than in the both-subcompartment group (33% [8 of 24] versus 67% [16 of 24]; odds ratio 0.25 [95% CI 0.08 to 0.83]; p = 0.02). CONCLUSION Our data suggest that a US-guided steroid injection targeting the EPB subcompartment alone is as effective in terms of pain reduction as targeting both subcompartments in patients with de Quervain disease who have complete septation. Furthermore, an injection targeting the EPB subcompartment alone can reduce the dose of steroids used, perhaps thereby decreasing complications related to steroid injections. We recommend using only single-compartment injections in this context, even among patients with an intracompartmental septum. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Suk Ho Baek
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
| | - Jae Sung Lee
- Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Republic of Korea
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McCool L, Tonkin B, Guo D, Guo D, Senk A. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16:644-649. [PMID: 31540554 PMCID: PMC8461189 DOI: 10.1177/1558944719873435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
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Affiliation(s)
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Medical Center, MN, USA
| | | | | | - Alexander Senk
- Minneapolis Veterans Affairs Medical Center, MN, USA,Alexander Senk, Department of Physical Medicine & Rehabilitation, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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Pereira Dias R, Janeiro J. Type II de Quervain's disease: depicting subcompartmentalisation with ultrasound. BMJ Case Rep 2021; 14:14/6/e242173. [PMID: 34155018 DOI: 10.1136/bcr-2021-242173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ricardo Pereira Dias
- Serviço de Imagiologia Geral, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - João Janeiro
- Serviço de Imagiologia Geral, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
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Kim SJ, Lee CH, Khil EK, Choi JA, Im WY, Lee KH. Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1553-1560. [PMID: 32045018 DOI: 10.1002/jum.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We performed preoperative ultrasonography (US) to detect the anatomic course of the superficial radial nerve (SRN) and dominant pathologic tendon of the first extensor compartment in de Quervain tenosynovitis. METHODS We prospectively studied 27 patients (29 wrists) with de Quervain tenosynovitis who underwent surgical release of the first extensor compartment. Preoperatively, US was performed to evaluate the presence of the dominant pathologic tendon and the septum in the subcompartment, number of SRNs in the area of the surgical incision, and anatomic running course of the SRN. These variables were also checked intraoperatively. Cohen κ statistics were calculated to investigate agreement between US and surgical field findings. RESULTS There were 7 men and 20 women (mean age, 47.8 years; range, 26-67 years). For the dominant pathologic tendon, there were 2 cases (6.9%) of an abductor pollicis longus, 11 cases (37.9%) of an extensor pollicis brevis, and 16 cases (55.2 %) of a nondominant tendon (κ = 0.94). For the subcompartment, there were 10 cases (34.5%) without a septum, 8 (27.6%) with an incomplete septum, and 11 (37.9%) with a complete septum (κ = 0.95). Most SRNs crossed over the first extensor compartment (κ = 0.78). CONCLUSIONS Preoperative US can be useful in detecting the anatomic running course of the SRN and dominant pathologic tendon before surgery for de Quervain tenosynovitis. Classifying the anatomic course of the SRN could be essential to planning surgery, and it could be helpful to prevent injury of the SRN during surgery.
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Affiliation(s)
- Sung-Jae Kim
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Woo-Young Im
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Kwang-Hyun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
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Abi-Rafeh J, Kazan R, Safran T, Thibaudeau S. Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm. Plast Reconstr Surg 2020; 146:105-126. [PMID: 32590652 DOI: 10.1097/prs.0000000000006901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonsurgical management of de Quervain disease relies mainly on the use of oral nonsteroidal antiinflammatory drug administration, splint therapy, and corticosteroid injections. Although the latter is most effective, with documented success rates of 61 to 83 percent, there exists no clear consensus pertaining to conservative treatment protocols conferring the best outcomes. This article reports on all present conservative treatment modalities in use for the management of de Quervain disease and highlights specific treatment- and patient-related factors associated with the best outcomes. METHODS A systematic search was performed using the PubMed database using appropriate search terms; two independent reviewers evaluated retrieved articles using strict inclusion and exclusion criteria. RESULTS A total of 66 articles met the inclusion criteria for review, consisting of 22 articles reporting on outcomes following a single conservative treatment modality, eight articles reporting on combined treatment approaches, 13 articles directly comparing different conservative treatment regimens, and 23 case reports. CONCLUSIONS A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation. Although there exists some evidence showing that multipoint injection techniques and multiple injections before surgical referral may provide benefit over a single point injection technique and a single injection before surgery, corticosteroid use is not benign and should thus be performed with caution. Ultrasound was proven valuable in the visualization of an intercompartmental septum, and ultrasound-guided injections were shown to both be more accurate and confer better outcomes. Several prior and concurrent medical conditions may affect conservative treatment outcome. A Level I to II evidence-based treatment protocol is recommended for the optimal nonsurgical management of de Quervain disease.
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Affiliation(s)
- Jad Abi-Rafeh
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Roy Kazan
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Tyler Safran
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
| | - Stephanie Thibaudeau
- From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center
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McBain B, Rio E, Cook J, Grabinski R, Docking S. Diagnostic accuracy of imaging modalities in the detection of clinically diagnosed de Quervain's syndrome: a systematic review. Skeletal Radiol 2019; 48:1715-1721. [PMID: 30888457 DOI: 10.1007/s00256-019-03195-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To collate and synthesise the literature to provide estimates of the diagnostic accuracy of imaging modalities, and summarise the reported imaging findings associated with de Quervain's syndrome. MATERIALS AND METHODS A systematic search was performed in seven databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PROSPERO, Web of Science, and ProQuest Dissertations & Theses Global). Two reviewers independently performed screening, data extraction and quality assessment using a modified Quality Assessment of Diagnostic Accuracy Studies-2. Measures of diagnostic accuracy were summarised for different modalities and imaging findings. RESULTS Twenty-two studies were included, reporting ultrasound, magnetic resonance imaging, X-ray and scintigraphy findings. Reported imaging findings included sheath effusion, retinaculum thickening, subcutaneous oedema, tenosynovitis, hypervascularity, increased tendon size, bony erosion, apposition, calcific lesions and increased uptake on scintigraphy. The most commonly reported imaging findings related to the tendon sheath, with a sensitivity ranging from 0.45 to 1.00 for thickening, and 0.29 to 1.00 for effusions. The risk of bias of studies is largely unclear owing to a lack of reported detail. CONCLUSIONS The accuracy of imaging in the diagnosis of de Quervain's syndrome is unable to be determined because of the quality of the studies included. Ultrasound is the most frequently studied imaging modality and may be the modality of choice in clinical practice. Further research involving both symptomatic and asymptomatic participants and clear definitions of abnormal findings are required to better evaluate the effectiveness of imaging in identifying de Quervain's syndrome.
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Affiliation(s)
- Brodwen McBain
- La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Rafal Grabinski
- Victoria House Medical Imaging, I-MED Radiology Network, Melbourne, Australia
| | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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US-guided percutaneous release of the first extensor tendon compartment using a 21-gauge needle in de Quervain's disease: a prospective study of 35 cases. Eur Radiol 2018; 28:3977-3985. [PMID: 29619521 DOI: 10.1007/s00330-018-5387-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the efficacy of ultrasonography-guided percutaneous treatment of de Quervain tenosynovitis with the combination of a corticosteroid injection and release of the retinaculum of the first extensor compartment tendons with a 21-gauge needle. MATERIALS AND METHODS The first part of our study consisted of ten procedures on cadaver wrists followed by dissection to analyse the effectiveness of the retinaculum release and detect any collateral damage. The second part was a prospective clinical study of 35 procedures. Outcomes were evaluated through a 6-month clinical follow-up and telephone interview at the end of the study. The following parameters were monitored over time: pain level on a visual analogue scale, the QuickDASH and the PRWE. Patient satisfaction questionnaires were also administered. RESULTS No complications were found during the cadaver study. However, the release was confirmed as 'partial' in all wrists. In the clinical portion of this study, significant improvement was observed in 91.4 % of cases (32/35) within 1 month and the results were stable until the end of the study; all of these patients avoided surgery. The release procedure failed in three patients who eventually required surgical treatment. CONCLUSION US-guided partial release and simultaneous corticosteroid injection for treatment of de Quervain's disease using a 21-gauge needle is feasible in current practice, with minimal complications. KEY POINTS • Ultrasound-guided treatment of de Quervain's disease is feasible with a 21G needle. • There was notable regression of clinical signs in 91.4 % of cases. • The procedure is very safe, no iatrogenic neurovascular or tendinous injuries occurred. • Our procedure requires only one session and 3 days away from work.
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Allam AES, Al-Ashkar DS, Negm AA, Eltawab BA, Wu WT, Chang KV. Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon? J Pain Res 2017; 10:2299-2302. [PMID: 29026332 PMCID: PMC5627726 DOI: 10.2147/jpr.s143256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
De Quervain disease (DQVD) is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times). After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist.
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Affiliation(s)
- Abdallah El-Sayed Allam
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa Shawky Al-Ashkar
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed A Negm
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
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Kang JW, Park JW, Lee SH, Park JH, Han SB, Park SY, Jeong WK. Ultrasound-guided injection for De Quervain's disease: Accuracy and its influenceable anatomical variances in first extensor compartment of fresh cadaver wrists. J Orthop Sci 2017; 22:270-274. [PMID: 28209340 DOI: 10.1016/j.jos.2016.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was designed to evaluate the accuracy of ultrasound-guided injection targeting EPB tendon sheath and influenceable anatomical variances to the accuracy in the first extensor compartment of fresh cadaver wrists. METHODS Thirty wrists of 15 cadavers were used. The wrists were divided into right-sided wrists (control group) and left-sided wrists (group A) to compare the accuracy of the manual injection technique (control group) and ultrasound-guided injection technique (group A) targeting EPB tendon sheath. To estimate the influence of anatomical variances within first extensor compartment to the accuracy of each injection techniques, control group (manual injection group) was divided into Control group I (right-sided wrists without septum) and II (right-sided wrists with septum) and group A (ultrasound-guided injection group) was also divided into group AI (left-sided wrists without septum) and group AII (left-sided wrists with septum), respectively. After the methylene blue dye injection, the location of methylene blue dye and anatomical variances in the first extensor compartment was identified by dissection. RESULTS The accuracy was higher in the group A (93.3%) than in control group (40.0%, p < 0.05). The accuracy in control group I (55.6%) was higher than in control group II (16.7%, p < 0.05). The accuracy between group AI (100%) and group AII (85.7%) was not significantly different (p > 0.05). Wrists with more EPB or APL tendon slips showed a tendency not to have septum and all intratendinous injections was occurred in the wrist with 1 EPB tendon slip or 1 or 2 APL tendon slip. CONCLUSIONS Ultrasound-guided injection targeting EPB tendon ensures correct needle placement through the visualization of compartmental anatomy and improves accuracy of injection though the septum in first extensor compartment encourage inaccurate injections.
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Affiliation(s)
- Jong Woo Kang
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Ansan Hospital, Ansan, South Korea
| | - Jong Woong Park
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Soon Hyuck Lee
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Jong Hoon Park
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Seung Bum Han
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Si Young Park
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Woong Kyo Jeong
- Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, South Korea.
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Danda RS, Kamath J, Jayasheelan N, Kumar P. Role of Guided Ultrasound in the Treatment of De Quervain Tenosynovitis by Local Steroid Infiltration. J Hand Microsurg 2016; 8:34-7. [PMID: 27616825 DOI: 10.1055/s-0036-1581123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Ultrasound guidance for steroid injection in de Quervain disease is useful in identifying the presence of subcompartments and effectively injecting the drug into tendon sheath. We prospectively studied 50 patients with features of de Quervain disease to determine the effectiveness of ultrasound in positioning of needle for steroid injection and effectiveness of single versus multiple injections in the presence of subcompartments. Scalp vein set was inserted into the tendon sheath under ultrasound guidance and sterile conditions. Mixture containing 1 mL of methylprednisolone 40 mg with 1 mL of 2% lignocaine was injected and the patient followed for 6 months. In patients having subcompartments, improvement was better when two separate injections into each subcompartment were given compared with single. Ultrasound guidance is helpful in identifying the existence of subcompartment and injecting the subcompartments separately. Scalp vein set may be very effective in ultrasound-guided injection. This is a level III study.
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Affiliation(s)
- Raja Shekar Danda
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore, India
| | - Jagannath Kamath
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore, India
| | - Nikil Jayasheelan
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore, India
| | - Prashanth Kumar
- Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Mangalore, India
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Gurses IA, Turkay R, Inci E, Ors S, Onal Y, Ozel S, Vural M. Sex differences in the radial grooves in the first extensor compartment. Skeletal Radiol 2016; 45:955-8. [PMID: 27040109 DOI: 10.1007/s00256-016-2381-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE De Quervain tenosynovitis affects the first extensor compartment of the wrist and occurs more frequently in females. This high prevalence could not be explained by soft tissue. As the osseous anatomy has been mostly neglected, we aimed to compare the distal radius between the sexes. MATERIALS AND METHODS We evaluated the presence of a bony ridge on the floor of the first extensor compartment on CT images with multiplanar imaging. RESULTS We included 244 wrists (72 females, 172 males) in the study. A bony ridge was present in 58 (23.8 %) and absent in 186 (76.2 %) wrists. A ridge was present in 24 (33.3 %) wrists among females and 34 (19.8 %) wrists among males. A groove with a bony ridge was statistically associated with females. CONCLUSION We observed two tendon groove morphologies for the first extensor compartment. A groove with a bony ridge occurs more frequently in females. Further research is needed to clarify the relationship between the high frequency of a bony ridge and increased prevalence of de Quervain tenosynovitis in females.
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Affiliation(s)
- Ilke A Gurses
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey.
| | - Rustu Turkay
- Department of Radiology, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam Caddesi, Bakırköy, Istanbul, 34147, Turkey
| | - Ercan Inci
- Department of Radiology, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam Caddesi, Bakırköy, Istanbul, 34147, Turkey
| | - Suna Ors
- Department of Radiology, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam Caddesi, Bakırköy, Istanbul, 34147, Turkey
| | - Yilmaz Onal
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
| | - Sevda Ozel
- Department of Biostatistics and Medical Informatics, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam Caddesi, Bakırköy, Istanbul, 34147, Turkey
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De Keating-Hart E, Touchais S, Kerjean Y, Ardouin L, Le Goff B. Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain's syndrome. J Hand Surg Eur Vol 2016; 41:212-9. [PMID: 26497593 DOI: 10.1177/1753193415611414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/14/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to find clinical or ultrasound characteristics that might predict the failure of conservative treatment in de Quervain's syndrome. A total of 42 ultrasound-guided injections have been performed in 41 patients after clinical and ultrasound examination. Patients were immobilized for 3 weeks with a spica splint cast, and clinically evaluated at 3 and 6 weeks and by phone call at the end of the study. Ultrasound showed a septum between the tendons of the first comportment in 34% of the wrists. At last follow-up (mean 15.6 months after the injection) ten patients (24%) had undergone surgery. When comparing ultrasound and clinical characteristics of the operated and non-operated wrists, we found that patients with a high baseline visual analogue scale, with all positive clinical tests and with a persistent intracompartmental septum, had a significantly higher risk of failure following conservative treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E De Keating-Hart
- Orthopaedic Surgery Department, University Hospital Hôtel Dieu, Nantes, France
| | - S Touchais
- Orthopaedic Surgery Department, University Hospital Hôtel Dieu, Nantes, France
| | - Y Kerjean
- Hand Surgery Unit, Jeanne d'Arc, Nantes, France
| | - L Ardouin
- Hand Surgery Unit, Jeanne d'Arc, Nantes, France
| | - B Le Goff
- Rheumatology Department, University Hospital Hôtel Dieu, Nantes, France
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17
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Sato J, Ishii Y, Noguchi H. Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease. J Hand Surg Eur Vol 2016; 41:220-5. [PMID: 26546605 DOI: 10.1177/1753193415614267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/02/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigated the demographic characteristics of patients who were diagnosed with intersection syndrome and also investigated the dominance of the affected hand, duration of symptoms and any precipitating factor for pain of the wrist. These features were compared with patients who had de Quervain's disease. Ultrasonography was used to confirm the clinical diagnosis. Intersection syndrome occurred more frequently in men and in the dominant hand than de Quervain's disease when all the patients were compared and when peripartum women were excluded. It occurred at a younger age than de Quervain's disease only when the comparison excluded peripartum women. Patients with intersection syndrome presented with a much shorter duration of symptoms. These results were consistent with previous reports about occupational factors in intersection syndrome, and might be helpful in the understanding of epidemiological difference between the two conditions. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- J Sato
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Y Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - H Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
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The anatomy of the fibrous and osseous components of the first extensor compartment of the wrist: a cadaveric study. Surg Radiol Anat 2015; 37:773-7. [PMID: 25645546 DOI: 10.1007/s00276-015-1439-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE De Quervain disease is the stenosing tenosynovitis of the first extensor compartment of the wrist. It is diagnosed with a history of pain at the radial aspect of the wrist and a positive Finkelstein test. Although anatomic variations, such as a septum within the compartment, are considered as risk factors, bony anatomy of distal radius and its correlation with the septa are studied scarcely in the literature. METHODS We dissected 50 wrists of 26 cadavers. Presence and location of a septum within the compartment was evaluated. We also observed the grooves at distal radius and their relation to the first extensor compartment and its content. RESULTS The septum was absent in 23 wrists (46%). A septum was present in 27 (54%) wrists (15 incomplete 30%, 12 complete 24%). At the distal radius, we classified three radial groove types as Type 1 on 28 (56%), Type 2 on 14 (28%), and as Type 3 on 8 (16%) wrists. There was a statistically significant relation between complete type of septa and Type 1 grooves (p = 0.002). CONCLUSION We investigated the bony structures of the compartment along with its content and we believe our results might guide clinicians who diagnose and treat de Quervain tenosynovitis.
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Goubau JF, Goubau L, Goorens CK, van Hoonacker P, Kerckhove D, Vanmierlo B, Berghs B. De Quervain Tenosynovitis Following Trapeziometacarpal Ball-and-Socket Joint Replacement. J Wrist Surg 2015; 4:35-42. [PMID: 25709877 PMCID: PMC4327722 DOI: 10.1055/s-0034-1398487] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is de Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the incidence of de Quervain disease during the first year following surgery. We found a particularly high incidence (17%) of de Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting de Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the development of de Quervain tendinopathy within one year after surgery.
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Affiliation(s)
- Jean F. Goubau
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Laurent Goubau
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Gent, Universiteit Gent (UG), Gent, Belgium
| | - Chul Ki Goorens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Hagelandse Orthopedische Praktijk, Regionaal Ziekenhuis Tienen, Tienen, Belgium
| | - Petrus van Hoonacker
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Diederick Kerckhove
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bert Vanmierlo
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
| | - Bart Berghs
- Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan AV Brugge – Oostende, AZ Sint Lucas, Brugge, Belgium
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20
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Irwin RW, Wolff ET. Assessment of neuromuscular conditions using ultrasound. Phys Med Rehabil Clin N Am 2014; 25:531-43, vii. [PMID: 25064787 DOI: 10.1016/j.pmr.2014.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Upper extremity pain in persons with spinal cord injury is a common cause of morbidity. Ultrasound of nerve, muscle, and tendon has the potential to become a valuable modality in assessing this population, and has the advantage of reduced health care costs, portability, and use in populations that cannot tolerate MRI. It has the potential to detect issues before the onset of significant morbidity, and preserve patient independence. Upper extremity ultrasound already has many studies showing its utility in diagnosis, and newer techniques have the potential to enhance its use in the diagnosis and management of musculoskeletal conditions.
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Affiliation(s)
- Robert W Irwin
- Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1120 North West 14th Street, Miami, FL 33136, USA; Medical Education, Miller School of Medicine, University of Miami, 1120 North West 14th Street, Miami, FL 33136, USA.
| | - Erin T Wolff
- Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1120 North West 14th Street, Miami, FL 33136, USA
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21
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Lok RLK, Griffith JF, Ng AWH, Wong CWY. Imaging of radial wrist pain. Part II: pathology. Skeletal Radiol 2014; 43:725-43. [PMID: 24522772 DOI: 10.1007/s00256-014-1826-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/06/2014] [Accepted: 01/11/2014] [Indexed: 02/02/2023]
Abstract
Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities.
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Affiliation(s)
- Ryan Lee Ka Lok
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Shatin, Hong Kong,
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22
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Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci 2014; 19:49-54. [PMID: 24132793 DOI: 10.1007/s00776-013-0481-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 09/23/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND This prospective cohort study was undertaken to explore the hypothesis that the retinaculum is thicker in de Quervain's disease and to identify another landmark for the presence of the intracompartmental septum. METHODS A case group (60 wrists) comprised of Korean female patients with unilateral de Quervain's disease and a healthy control group (60 wrists) were evaluated by ultrasonography. The case group underwent surgery for extensor retinacular release, and surgical findings were used as the reference standard. The mean extensor retinacular thickness in the case and control groups was compared using a Wilcoxon rank-sum test. A receiver operation characteristic curve was constructed for the parameter. RESULTS The mean thickness of the extensor retinaculum was 0.94 mm (SD 0.37) in the case group and 0.35 mm (SD 0.07) in the control group, and this difference was significant. The cutoff value of the extensor retinaculum for diagnosing de Quervain's disease was 0.45 mm (sensitivity 96.3%, specificity 93.3%). Bony crests were found in all cases of presence of the intracompartmental septum and could be classified into three types according to shape. CONCLUSIONS We concluded that the extensor retinaculum is thicker in de Quervain's disease. And the bony crest on the radial styloid can be considered a new landmark for determining the presence of an intracompartmental septum. TYPE OF STUDY AND LEVEL OF EVIDENCE Diagnostic, level II.
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23
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Chang KV, Chen WS, Wang TG. Application of High Frequency Ultrasound on Wrist Joints. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Karthik K, Carter-Esdale CW, Vijayanathan S, Kochhar T. Extensor Pollicis Brevis tendon damage presenting as de Quervain's disease following kettlebell training. Sports Med Arthrosc Rehabil Ther Technol 2013; 5:13. [PMID: 23731737 PMCID: PMC3680204 DOI: 10.1186/2052-1847-5-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/29/2013] [Indexed: 01/20/2023]
Abstract
Kettlebell exercises are more efficient for an athlete to increase his or her muscle strength. However it carries the risk of injury especially in the beginners. A 39 year old gentleman came to our clinic with radial sided wrist pain following kettlebell exercises. Clinically patient had swelling and tenderness over the tendons in the first dorsal wrist compartment, besides Finklesten test was positive. Patient had a decreased excursion of the thumb when compared to the opposite side. Ultrasound/MRI scan revealed asymmetric thickening of the 1st compartment extensors extending from the base of the thumb to the wrist joint. Besides injury to the Extensor Pollicis Brevis (EPB) tendon by repetitive impact from kettlebell, leading to its split was identified. Detailed history showed that the injury might be due to off-centre handle holding during triceps strengthening exercises. Our report stresses the fact that kettlebell users should be taught about problems of off-center handle holding to avoid wrist injuries. Also, in Kettlebell users with De Quervains disease clinical and radiological evaluation should be done before steroid injection as this might lead to complete tendon rupture.
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Elhai M, Guerini H, Bazeli R, Avouac J, Freire V, Drapé JL, Kahan A, Allanore Y. Reply. Arthritis Care Res (Hoboken) 2013; 65:1016. [DOI: 10.1002/acr.21941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Muriel Elhai
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Henri Guerini
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Ramin Bazeli
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Jerôme Avouac
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Véronique Freire
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Jean-Luc Drapé
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - André Kahan
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
| | - Yannick Allanore
- Paris Descartes University; Sorbonne Paris Cité and Cochin Hospital; AP-HP; Paris; France
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Vuillemin V, Guerini H, Morvan G. Musculoskeletal interventional ultrasonography: the upper limb. Diagn Interv Imaging 2012; 93:665-73. [PMID: 22921692 DOI: 10.1016/j.diii.2012.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Forty percent of the 823 ultrasound-guided injections performed in our centre over a year and a half concerned the upper limb, injections involving the shoulder, for subacromial bursitis and the treatment of calcific tendinitis, being the prime indications (24%). The wrist represented 8% of the prescriptions, for treatment of tendinopathy, ganglion cysts, carpal tunnel syndrome and rhizarthrosis. Trigger finger, tenosynovitis and pulley ganglia made up 6% of the indications and the elbow 2.5%. Ultrasound improves the accuracy of the procedure by helping guide the path of the needle and allowing the distribution of the substance injected to be visualised. We shall give details of the technique used for each indication, with advice and hints and post-procedure recommendations.
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Affiliation(s)
- V Vuillemin
- Imagerie médicale Léonard de Vinci, Paris, France.
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Kume K, Amano K, Yamada S, Amano K, Kuwaba N, Ohta H. In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. J Hand Surg Eur Vol 2012; 37:523-7. [PMID: 22095403 DOI: 10.1177/1753193411427829] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared ultrasonography (US)-guided injection, targeting the extensor pollicis brevis (EPB) in de Quervain's disease (dQD) with septation, to clinical injection. Forty-four wrists were randomly allocated to US-guided or manual (non-US-guided) injection. At 4 weeks, pain was significantly reduced in both groups. Pain on the 100 mm visual analogue scale (VAS) for the US group was 80.3 (SD 19.6) mm at baseline and 25.6 (SD 15.1) mm at 4 weeks after injection (p = 0.004). Values for the manual group were 78.0 (SD 18.5) mm at baseline and 58.2 (SD 21.9) mm at 4 weeks after injection (p = 0.04). Pain on the VAS showed a more significant decrease in the US-guided than in the manual injection group (p = 0.0007) from baseline to 4 weeks after injection. The results of this study suggest US-guided injection targeting the EPB in dQD patients with septation is more effective than manual injection.
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Affiliation(s)
- K Kume
- Department of Rheumatology, Hiroshima Clinic, Hiroshima City, Hiroshima, Japan.
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28
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Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res 2012; 470:1925-31. [PMID: 22552767 PMCID: PMC3369070 DOI: 10.1007/s11999-012-2369-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 04/13/2012] [Indexed: 01/31/2023]
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.
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Abstract
Tenosynovitis refers to an inflammatory condition involving the synovial sheath of a tendon. Stenosing tenosynovitis is a peculiar entity caused by multiple factors, including local anatomy, mechanical factors, and hormonal factors. The main forms include de Quervain tendinopathy; trigger finger (stenosing tenosynovitis involving the flexor digitorum tendons); stenosing tenosynovitis of the extensor carpi ulnaris, extensor carpi radialis, or extensor comunis tendons; stenosing tenosynovitis of the flexor hallucis tendon; and stenosing tenosynovitis of the peroneal tendons. The cardinal finding on ultrasonography is the presence of a thickened retinaculum or pulley that constricts the osseofibrous tunnel through which the tendon runs.
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Affiliation(s)
- V Vuillemin
- Imagerie Médicale Léonard de Vinci, Paris, France
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Rousset P, Vuillemin-Bodaghi V, Laredo JD, Parlier-Cuau C. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology 2010; 257:427-33. [PMID: 20829530 DOI: 10.1148/radiol.10092265] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the accuracy of ultrasonography (US) in determining the anatomic variations in the first extensor compartment of the wrist. MATERIALS AND METHODS Approval from the anatomic donations department was obtained. The first extensor compartment of the wrist of 40 nonembalmed cadaveric forearms (15 male and 25 female; age range at death, 65-100 years) were assessed at US by two observers for the presence or absence of a vertical septum, the presence or absence of an osseous ridge with a double groove in the bony floor, and whether there were single or multiple slips of the abductor pollicis longus and the extensor pollicis brevis tendons. These findings were also evaluated at dissection. RESULTS The accuracies of US in depicting a septum and an osseous ridge with a double groove were respectively 95% (95% confidence interval [CI]: 83%, 99%) and 100% (95% CI: 91%, 100%). At dissection, a septum was invariably associated with the presence of an osseous ridge. The accuracies of US in depicting multiple tendon slips of the abductor pollicis longus and the extensor pollicis brevis were respectively 80% (95% CI: 64%, 91%) and 97% (95% CI: 86%, 100%). CONCLUSION US was highly accurate in depicting anatomic variations in the first extensor compartment. US detection of an osseous ridge was an indirect sign of the presence of a septum dividing the first extensor compartment into two subcompartments.
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Affiliation(s)
- Pascal Rousset
- Department of Radiology, Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel Dieu, 1 Place du Parvis Notre Dame, 75004 Paris, France.
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