Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome

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.

[1]  P. Hoogvliet,et al.  Consensus on a Multidisciplinary Treatment Guideline for de Quervain Disease: Results From the European HANDGUIDE Study , 2014, Physical Therapy.

[2]  B. Berghs,et al.  The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test , 2014, The Journal of hand surgery, European volume.

[3]  Chang-Nam Kang,et al.  Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain’s disease , 2014, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[4]  A. Iagnocco,et al.  Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis , 2012, Annals of the rheumatic diseases.

[5]  V. Devadoss,et al.  Systematic review and meta-analysis on steroid injection therapy for de Quervain’s tenosynovitis in adults , 2014, European Journal of Orthopaedic Surgery & Traumatology.

[6]  N. Kuwaba,et al.  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 , 2012, The Journal of hand surgery, European volume.

[7]  L. Nazarian,et al.  Ultrasound-guided Injections for de Quervain’s Tenosynovitis , 2012, Clinical orthopaedics and related research.

[8]  J. Ahn,et al.  de Quervain disease: US identification of anatomic variations in the first extensor compartment with an emphasis on subcompartmentalization. , 2011, Radiology.

[9]  Y. Endo.  Sonographic Identification of the Intracompartmental Septum in de Quervain's Disease , 2010 .

[10]  W. Grassi,et al.  Ultrasound differentiation of two types of de Quervain's disease: the role of retinaculum , 2009, Annals of the rheumatic diseases.

[11]  S. Trigg.  Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease , 2010 .

[12]  K. Groenier,et al.  Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice , 2009, BMC musculoskeletal disorders.

[13]  D. A. van der Windt,et al.  Corticosteroid injection for de Quervain's tenosynovitis. , 2009, The Cochrane database of systematic reviews.

[14]  K. Jeyapalan,et al.  Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease , 2009, Skeletal Radiology.

[15]  S. Saengnipanthkul,et al.  Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. A randomized, double-blind, placebo-controlled trial. , 2004, The Journal of bone and joint surgery. American volume.

[16]  C. Cooper,et al.  Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. , 2004, Arthritis and rheumatism.

[17]  G. Foucher,et al.  The anatomy of de Quervain's disease , 1995, International Orthopaedics.

[18]  W. Briner,et al.  Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. , 2003, The Journal of the American Board of Family Practice.

[19]  H. Matsuzaki,et al.  Ultrasonographic examination of de Quervain's disease , 2000, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[20]  M. V. van Holsbeeck,et al.  Injection accuracy and clinical relief of de Quervain's tendinitis. , 1998, The Journal of hand surgery.

[21]  A. Galli,et al.  [Ultrasonic diagnosis of De Quervain's stenosing tenosynovitis]. , 1997, La Radiologia medica.

[22]  M. Gonzalez,et al.  The first dorsal extensor compartment: an anatomic study. , 1995, The Journal of hand surgery.

[23]  M. Brouns,et al.  Treatment of De Quervain's tenosynovitis with corticosteroids. A prospective study of the response to local injection. , 1991, Arthritis and rheumatism.

[24]  C. Peimer,et al.  De Quervain's syndrome: surgical and anatomical studies of the fibroosseous canal. , 1991, Orthopedics.

[25]  B. Leslie,et al.  Incidence of a septum within the first dorsal compartment of the wrist. , 1990, The Journal of hand surgery.

[26]  V. Visuthikosol,et al.  Surgical treatment of de Quervain's diseases: a clinical review of 42 cases. , 1988, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[27]  K. W. Giles.  Anatomical variations affecting the surgery of de Quervain's disease. , 1960, The Journal of bone and joint surgery. British volume.