Ultrasound-guided injections for de Quervain's tenosynovitis

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.

Figures

Fig. 1

The drawing shows the ultrasound probe position over the first dorsal compartment that provides a transverse sonographic image to aid in ultrasound-guided injections for de Quervain’s tenosynovitis. P = probe; R = radius; U = ulna.

Fig. 2A–B

Transverse axis sonogram of the first dorsal compartment show (A) a single compartment versus (B) two subcompartments. APL = abductor pollicis longus; EPB = extensor pollicis brevis; R = radial; U = ulnar. The presence of hypoechoic or anechoic material between the two tendons as seen in B also can be seen with a tendon sheath effusion and is not necessarily diagnostic of a septum. However, on injection there was no communication seen between two tendons.