1
|
Lee HI, Lee HI, Lee S, Song WC. Cutaneous nerve distribution around first extensor compartment of the wrist: Clinical implications for ultrasound-guided injections. JPRAS Open 2024; 39:321-329. [PMID: 38380184 PMCID: PMC10878833 DOI: 10.1016/j.jpra.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To evaluate the course of the cutaneous nerve regarding the first extensor compartment to determine whether the dorsal or volar approach is safer for local injection into the first extensor compartment guided by ultrasound. Methods We dissected the radial side of the wrists from 28 cadavers (52 wrists). Four-points along the imaginary line were set: the styloid process and 1 cm, 2 cm, and 3 cm proximal to the styloid process. The numbers of superficial radial nerve (SRN) and lateral antebrachial cutaneous nerve (LACN) branches were counted, and distances from the imaginary line at these points and nerve diameters were recorded. Digital images were superimposed to observe overall distribution of cutaneous nerve. Results There were means of 3.3 SRN and 0.9 LACN branches observed in each wrist. The mean number of both SRN and LACN branches was 2.3 on the dorsal side and 1.9 on the volar side. The superimposed images indicated that both the dorsal and volar sides comprised abundant cutaneous nerves and that their paths varied markedly between patients. However, we observed that larger nerves with meaningful diameters were more abundant on the dorsal than the volar side. Conclusion There were similar numbers of cutaneous nerves on both the dorsal and volar sides; however, we observed greater abundance of thicker cutaneous nerves on the dorsal side, and these were closer to the reference line than on the volar side. This anatomical study suggests that the risk imposed to cutaneous nerves would therefore be reduced when injection on the volar side.
Collapse
Affiliation(s)
- Hyun Il Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Republic of Korea
| | - Hye-In Lee
- Department of Anatomy, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Soonchul Lee
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 11, Yatap-ro 65beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Wu-Chul Song
- Department of Oral Anatomy and Developmental Biology, College of Dentistry, Kyung Hee University, Seoul, 02447, Republic of Korea
| |
Collapse
|
2
|
Coşkun O, Ok F, Şahin B, Gürses İA. First extensor compartment morphology and clinical significance: a cadaver series study. Anat Cell Biol 2023; 56:328-333. [PMID: 36987785 PMCID: PMC10520861 DOI: 10.5115/acb.23.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
The first extensor compartment of the wrist is a distinctly variable anatomical area. Anatomical variations in this region contribute to the pathophysiology and treatment failure of de Quervain's disease, which is a kind of tenosynovitis that develops in the first extensor compartment of the wrist. We aim to describe the first extensor compartment morphology, to evaluate the septum frequency, location of the septum, and the number of tendons of abductor pollicis longus (APL) and extensor pollicis brevis muscles (EPB). First extensor compartment of 87 wrists of 45 cadavers were dissected. The presence or absence of septum and number of tendon slips of APL and EPB revealed. The proximal and distal widths of the compartments were measured. Septums were detected in 60.9% (n=53) of the wrists. Incomplete (distal) and complete (proximal) septa were present in 35.6% (n=31) and 25.3% (n=22) of the cases. Only 26.4% of the wrists had a single slip of APL tendon. The Remaining had multiple slips. The median inner width of the proximal and distal compartments in all wrists were calculated as in the order of 9.11±1.14 mm and 8.55±1.12 mm. We believe that understanding the anatomy of the first extensor compartment in the Turkish population would be helpful to surgeons, radiologists, and physiotherapists to diagnose and manage de Quervain's disease.
Collapse
Affiliation(s)
- Osman Coşkun
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Ok
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Büşra Şahin
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - İlke Ali Gürses
- Department of Anatomy, Faculty of Medicine, Koc University, Istanbul, Turkey
| |
Collapse
|
3
|
Kotzias D, Koutserimpas C, Chrysikos D, Bekos F, Georgakopoulos P, Tsakotos G, Salmas M, Piagkou M, Troupis T. Clinical Considerations of First Extensor Wrist Compartment (FEWC) Variants and De Quervain's Disease: A Review Study. Cureus 2023; 15:e42124. [PMID: 37602034 PMCID: PMC10437001 DOI: 10.7759/cureus.42124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
The first extensor wrist compartment (FEWC) displays significant variants. This review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain's tenosynovitis. A thorough search of PubMed and MEDLINE databases, following the PRISMA guidelines, was conducted from 2002 to 2022 to evaluate all FEWC variants, including the following: 1) the presence of an inter-tendinous septum, 2) the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3) their distal insertions and 4) the presence of a bony ridge within the FEWC. A total of 3878 wrists (1277 cadaveric and 1296 de Quervain patients) were included. Of the 1234 cadavers, a total of 701 (56.8%) were males and 533 (43.2%) were females. Regarding the 883 patients, 178 (20.2%) of them were males and 705 (79.8%) were females. An inter-tendinous septum was identified in 42.9% (47% of the patients' wrists compared to 39.3% of the cadaveric wrists, p<0.0001). Cadaveric wrists presented two or more slips for the APL in a significantly higher percentage (92.5%, p < 0.0001) compared to de Quervain patients' wrists (74.5%). Regarding the EPB muscle, de Quervain patients' wrists had a single slip in 93% (p=0.0007) and two or more slips in 3.6%, compared to cadaveric wrists (a single slip in 87%, and two or more slips in 11%, p< 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients' wrists (p < 0.0001). Remarkable diversity concerning the structures within the FEWC was reported. The presence of an inter-tendinous septum dividing the FEWC and a single EPB muscle slip is more likely to be found in patients with de Quervain's disease.
Collapse
Affiliation(s)
- Dimitrios Kotzias
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | | | - Filippos Bekos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | | - George Tsakotos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Marios Salmas
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Theodore Troupis
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
4
|
Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023; 107:105-114. [PMID: 35195844 PMCID: PMC10020267 DOI: 10.1007/s12306-022-00735-0] [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: 09/28/2020] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.
Collapse
Affiliation(s)
| | | | - A M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| |
Collapse
|
5
|
Asaad SK, Mahmood KA, Arif SO, Abdalla BA, Salih AM, Kakamad FH, Mohammed SH, Salih RQ, Mohammed KK, Salih KM. Efficacy of ultrasound‑guided platelet rich plasma injection for the management of de Quervain's tenosynovitis. MEDICINE INTERNATIONAL 2023; 3:12. [PMID: 36875820 PMCID: PMC9982492 DOI: 10.3892/mi.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization.
Collapse
Affiliation(s)
- Saywan K Asaad
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq.,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Kawa A Mahmood
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Sakar O Arif
- Department of Radiology, Shar Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Berun A Abdalla
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | - Abdulwahid M Salih
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq.,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Fahmi H Kakamad
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq.,Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | | | - Rawezh Q Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | - Karukh K Mohammed
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | - Karzan M Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
Abi-Rafeh J, Mojtahed Jaberi M, Kazan R, Alabdulkarim A, Boily M, Thibaudeau S. Utility of Ultrasonography and Significance of Surgical Anatomy in the Management of de Quervain Disease: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022; 149:420-434. [PMID: 35077418 DOI: 10.1097/prs.0000000000008792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of ultrasound in plastic surgery practice has grown significantly over the past decade, with notable applications for conditions of the upper extremity. Its utility for the management of de Quervain disease, however, remains to be established, and the prevalence of first dorsal compartment anatomical variations needs to be adequately assessed. METHODS A systematic review was performed to evaluate the role of ultrasound in the diagnosis, anatomical characterization, and clinical management of de Quervain disease. A meta-analysis was conducted to establish the prevalence of first dorsal compartment anatomical variations in the de Quervain disease and general population, along with the diagnostic accuracy of ultrasound for their detection. Outcomes were documented and compared to alternative treatment options. RESULTS Extensor retinaculum thickening, tendon sheath swelling, peritendinous edema, and tendon enlargement were the most common sonographic features of de Quervain disease. The prevalence of an intercompartmental septum in the de Quervain disease surgical population was shown to be significantly greater than in the general cadaveric population (67 percent versus 35 percent, respectively). Although the efficacy of energy-based therapeutic ultrasound remains elusive, ultrasound-guided corticosteroid injections were shown to be more accurate than manual injections (90 to 100 percent versus 40 to 100 percent), and to confer significantly better treatment outcomes (73 to 100 percent versus 59 to 83 percent success rates, respectively). CONCLUSIONS Ultrasound use is essential to achieve the best evidence-based outcomes in the management of de Quervain disease. The varied prevalence of first dorsal compartment anatomical variations and high accuracy of ultrasound for their detection carry significant prognostic implications.
Collapse
Affiliation(s)
- Jad Abi-Rafeh
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Mehrad Mojtahed Jaberi
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Roy Kazan
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Abdulaziz Alabdulkarim
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Mathieu Boily
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| | - Stephanie Thibaudeau
- From the Departments of Medicine and Diagnostic Radiology and Divisions of Plastic and Reconstructive Surgery and Experimental Surgery, McGill University
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Beutel BG, Doscher ME, Melone CP. Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study. Hand (N Y) 2020; 15:348-352. [PMID: 30428712 PMCID: PMC7225884 DOI: 10.1177/1558944718810864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The reported prevalence of a subcompartment housing the extensor pollicis brevis (EPB) tendon within the first dorsal compartment varies widely in the literature, especially regarding the rates of occurrence between genders and among those with and without De Quervain. Based on direct intraoperative observation, we hypothesized that the prevalence of a septated compartment is far greater than previously reported, particularly in those with De Quervain disease. Methods: A prospective analysis of consecutive patients who underwent first dorsal compartment release was carried out. Patients were divided into 2 groups: those with De Quervain tenosynovitis ("De Quervain" group) and a control cohort without a primary diagnosis of De Quervain ("non-De Quervain" group). The intraoperative findings of a single compartment or a separate subcompartment were recorded. The prevalence of a septated compartment was calculated and compared between genders and both patient groups. Results: A total of 102 consecutive patients were included, with a female predominance (74.5%). Overall, 79.4% of patients had a separate subcompartment for the EPB. In the De Quervain cohort, 89.1% had 2 compartments, while 71.4% of non-De Quervain patients had a subcompartment. Men and women had a similar rate of double compartments (80% and 82.4%, respectively). Conclusions: The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients afflicted with De Quervain tenosynovitis. This higher rate of septation occurs with a similar prevalence in both men and women. Owing to its consistent presence, the dual first dorsal compartment should be regarded as an expectant anatomical component of the normal wrist.
Collapse
Affiliation(s)
- Bryan G. Beutel
- Mount Sinai Beth Israel, New York, NY, USA,Bryan G. Beutel, Department of Orthopaedic Surgery, The Hand Surgery Center, Mount Sinai Beth Israel, 321 East 34th Street, New York, NY 10016, USA.
| | | | | |
Collapse
|
10
|
Roh YH, Hong SW, Gong HS, Baek GH. Ultrasound-guided versus blind corticosteroid injections for De Quervain tendinopathy: a prospective randomized trial. J Hand Surg Eur Vol 2018; 43:820-824. [PMID: 30079791 DOI: 10.1177/1753193418790535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED A total of 154 patients with De Quervain tendinopathy were randomized into a blind injection group or an ultrasound-guided injection group to compare effectiveness and complications of steroid injection. The visual analogue scale score for pain, Finkelstein test result, and Disability of the Arm, Shoulder, and Hand (DASH) score were assessed at 12 and 24 weeks follow-up. At 12 weeks, the DASH scores were significantly better in the ultrasound-guided group, but the mean difference was less than the minimum clinically important difference. There was no difference in the DASH scores between the groups at 24 weeks. The pain scores were not significantly different between the two groups at 12 and 24 weeks. The incidence of treatment failure did not significantly differ between two groups. Incidences of soft tissue atrophy or skin depigmentation were significantly greater in patients with blind injection than with ultrasound-guided injection. We conclude that ultrasound-guided steroid injection for De Quervain tendinopathy reduces steroid-associated complications but has similar pain relieving and functional outcomes as blind injection. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Young Hak Roh
- 1 Department of Orthopaedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seok Woo Hong
- 1 Department of Orthopaedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- 2 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- 2 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Xu H, Wu JX, Wang Q, Gao ZY. Anatomical variations in the first extensor compartment: a cadaver study. ANZ J Surg 2018; 88:913-916. [PMID: 30117658 DOI: 10.1111/ans.14808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. METHODS The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. RESULTS In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. CONCLUSION Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.
Collapse
Affiliation(s)
- Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ji-Xia Wu
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qiang Wang
- Department of Rehabilitation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zheng-Yu Gao
- Department of Rehabilitation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
12
|
Kutsikovich J, Merrell G. Accuracy of Injection Into the First Dorsal Compartment: A Cadaveric Ultrasound Study. J Hand Surg Am 2018; 43:777.e1-777.e5. [PMID: 29478620 DOI: 10.1016/j.jhsa.2018.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 01/01/2018] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy of ultrasound-guided (UG) injections compared with anatomic landmark-guided (AL) injections in the first dorsal compartment (FDC) with the hypothesis that ultrasound guidance would increase the accuracy of injection. METHODS We randomized 43 above-elbow cadaveric specimens to receive latex dye injections into the FDC via a UG or AL technique. If ultrasound imaging identified a septated FDC, the needle was redirected and a portion of the dye was injected around the extensor pollicis brevis (EPB) tendon. Specimens were dissected and data collected regarding the location of the dye and presence of a septated FDC. Fisher exact test was used to calculate the difference in accuracy rates of injections. RESULTS All 21 specimens injected via UG and all 22 specimens injected via the AL technique demonstrated dye within the FDC. Eight of 21 specimens in the UG group and 6 of 22 specimens in the AL group demonstrated a septated FDC upon dissection. Ultrasound was able to identify 6 of 8 specimens accurately with a septated FDC, representing a sensitivity of 75% and specificity of 92%. Six of 8 specimens with a septated FDC in the UG group versus 2 of 6 specimens with a septated FDC in the AL group demonstrated dye infiltration around the EPB. Dye was noted in the subcutaneous tissues in 2 of 21 specimens in the UG group versus 2 of 22 specimens in the AL group. CONCLUSIONS The UG- and AL-based injections both had excellent dye infiltration into a portion of the FDC. Ultrasound-guided injections had a higher observed infiltration rate in EPB subcompartments than the AL technique, but could not be statistically confirmed to be different. CLINICAL RELEVANCE Ultrasound is unlikely to increase the accuracy of injections into an unseptated FDC. It may aid in injection of a septated FDC; however, that remains to be statistically demonstrated.
Collapse
|
13
|
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.
Collapse
|
14
|
Gao ZY, Tao H, Xu H, Xue JQ, Ou-Yang Y, Wu JX. A novel classification of the anatomical variations of the first extensor compartment. Medicine (Baltimore) 2017; 96:e7875. [PMID: 28858099 PMCID: PMC5585493 DOI: 10.1097/md.0000000000007875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The presence of a septum in the first extensor compartment is closely associated with the pathophysiology of de Quervain disease, and affects the efficacy of corticosteroid injection and surgical release. This study aimed to examine the incidence and length of the first extensor compartment septum.Forty sides of the wrists in 20 cadavers were used. The presence of a septum in the first extensor compartment was examined. The septum length was recorded with the radial styloid process as the reference point.The anatomical variations of the first extensor compartment were classified into 3 types. Type I compartment was found in 7 sides in males (29.2%) versus 6 sides in females (37.5%, P = .733), type II was found in 6 sides in males (25%) versus 1 side in females (6.25%, P = .21), and type III was found in 11 sides in males (45.8%) versus 9 sides in females (56.25%, P = .56). There was no significant difference in the septum length between males and females (5.3 ± 2.3 vs 4.8 ± 1.1 mm, P = .54).The incidence of a septum in the first extensor compartment is approximately 50%. The mean septum length is 5 mm. Injection at 5 mm proximal to the radial styloid process has a great chance of delivering the steroids into both subcompartments. Exposure to 5 mm proximal to the radial styloid process can avoid the overlook of subcompartment and achieve adequate decompression of the first extensor compartment.
Collapse
Affiliation(s)
| | - Hao Tao
- Department of Trauma Surgery
| | - Hao Xu
- Department of Joint Surgery
| | | | | | - Ji-Xia Wu
- Department of Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study. Plast Reconstr Surg Glob Open 2016; 4:e1022. [PMID: 27826460 PMCID: PMC5096515 DOI: 10.1097/gox.0000000000001022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/08/2016] [Indexed: 01/08/2023]
Abstract
Background: To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand. Methods: Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated. Results: Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 ± 30 cm, and the mean number of tendons was 2.75 ± 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications. Conclusions: Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment. Clinical Relevance: Release with a percutaneous needle tip in De Quervain’s syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Interventional Musculoskeletal Ultrasound. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
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.
Collapse
|
21
|
Efficacy of Acupuncture versus Local Methylprednisolone Acetate Injection in De Quervain's Tenosynovitis: A Randomized Controlled Trial. J Acupunct Meridian Stud 2014; 7:115-21. [DOI: 10.1016/j.jams.2013.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 08/20/2013] [Indexed: 11/18/2022] Open
|
22
|
Navarro-Zarza JE, Hernández-Díaz C, Saavedra MA, Alvarez-Nemegyei J, Kalish RA, Canoso JJ, Villaseñor-Ovies P. Preworkshop knowledge of musculoskeletal anatomy of rheumatology fellows and rheumatologists of seven North, Central, and South American countries. Arthritis Care Res (Hoboken) 2014; 66:270-6. [PMID: 23983095 DOI: 10.1002/acr.22114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/07/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To report the baseline knowledge of clinical anatomy of rheumatology fellows and rheumatologists from Argentina, Chile, Ecuador, El Salvador, Mexico, the US, and Uruguay. METHODS The invitation to attend a workshop in clinical anatomy was an open call by national rheumatology societies in 4 countries or by invitation from teaching program directors in 3 countries. Prior to the workshop, a practical test of anatomic structures commonly involved in rheumatic diseases was administered. The test consisted of the demonstration of these structures or their function in the participant's or instructor's body. At one site, a postworkshop practical test was administered immediately after the workshop. RESULTS There were 170 participants (84 rheumatology fellows, 61 rheumatologists, and 25 nonrheumatologists). The overall mean ± SD number of correct answers was 46.6% ± 19.9% and ranged from 32.5-67.0% by country. Rheumatology fellows scored significantly higher than nonrheumatologists. Questions related to anatomy of the hand scored the lowest of the regions surveyed. CONCLUSION Rheumatology fellows and rheumatologists showed a deficit in knowledge of musculoskeletal anatomy that is of central importance in rheumatologic assessment and diagnosis. This gap may hinder accurate and cost-effective rheumatologic diagnosis, particularly in the area of regional pain syndromes. Presently, widespread use of musculoskeletal ultrasound (MSUS) by rheumatologists may be premature, since a key component of expert-level MSUS is the integration of an accurate knowledge of anatomy with the views obtained with the ultrasound probe.
Collapse
Affiliation(s)
- José E Navarro-Zarza
- Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, Mexico
| | | | | | | | | | | | | |
Collapse
|
23
|
Hajder E, de Jonge MC, van der Horst CMAM, Obdeijn MC. The role of ultrasound-guided triamcinolone injection in the treatment of de Quervain's disease: treatment and a diagnostic tool? ACTA ACUST UNITED AC 2013; 32:403-7. [PMID: 24139754 DOI: 10.1016/j.main.2013.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/23/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to describe the technique and usefulness of ultrasound-guided intrasheath injection of triamcinolone in the treatment of de Quervain's disease (dQD). Our study was retrospective in design. Seventy-one wrists of 62 patients who were treated with an ultrasound-guided triamcinolone injection for dQD were included. A literature search was performed to compare our results. In the literature we found supportive evidence that accurate injection of triamcinolone in the first dorsal compartment of the wrist is important for a good outcome. In this retrospective study we found that treatment with ultrasound-guided injections of triamcinolone is both safe and effective. After two injections, 91% of the patients had good long-term results, which is a higher cure rate than found in most other studies. Furthermore, we found that Finkelstein's test can give a false positive result. Therefore, ultrasound should not only be considered to improve the treatment outcome, but can also be useful as a diagnostic tool in the management of de Quervain's disease.
Collapse
Affiliation(s)
- E Hajder
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
| | - M C de Jonge
- Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands
| | - C M A M van der Horst
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
| | - M C Obdeijn
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
| |
Collapse
|
24
|
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.
Collapse
|
25
|
Turner R. Commentary on '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' by K. Kume et al. J Hand Surg Eur. 2012, 37: 523-527. J Hand Surg Eur Vol 2012; 37:528. [PMID: 22753394 DOI: 10.1177/1753193412446272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Robert Turner
- Department of Trauma and Orthopaedics, Princess Royal Hospital, Telford and The Royal Shrewsbury Hospital, Shropshire, UK.
| |
Collapse
|