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European Radiology

, Volume 28, Issue 9, pp 3977–3985 | Cite as

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

  • Franck Lapègue
  • Aymeric André
  • Etienne Pasquier Bernachot
  • Ezin Jocelyn Akakpo
  • Pierre Laumonerie
  • Hélène Chiavassa-Gandois
  • Omar Lasfar
  • Christophe Borel
  • Marine Brunet
  • Olivia Constans
  • Hubert Basselerie
  • Nicolas Sans
  • Marie Faruch-Bilfeld
Musculoskeletal

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.

Keywords

De Quervain disease Tendon entrapment Ultrasonography, interventional Injections, intralesional Tenotomy 

Abbreviations

APL

Abductor Pollicis Longus

EPB

Extensor Pollicis Brevis

PRWE

Patient Rated Wrist Evaluation

Quick DASH

Quick Disabilities of the Arm, Shoulder and Hand outcome measure

RNSB

Radial nerve’s sensory branch

VAS pain

Visual analogue scale for pain

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr Franck Lapègue.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5387_MOESM2_ESM.docx (5.1 mb)
ESM 2 (DOCX 5.09 mb)

References

  1. 1.
    de Quervain F (1997) On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop Belle Mead NJ 26:641–644PubMedGoogle Scholar
  2. 2.
    Finkelstein H (1930) Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg Am:509–540Google Scholar
  3. 3.
    Petit Le Manac’h A, Roquelaure Y, Ha C et al (2011) Risk factors for de Quervain’s disease in a French working population. Scand J Work Environ Health 37:394–401CrossRefPubMedGoogle Scholar
  4. 4.
    Walker-Bone K, Palmer KT, Reading I et al (2004) Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 51:642–651CrossRefPubMedGoogle Scholar
  5. 5.
    Wolf JM, Sturdivant RX, Owens BD (2009) Incidence of de Quervain’s tenosynovitis in a young, active population. J Hand Surg 34:112–115CrossRefGoogle Scholar
  6. 6.
    Anderson SE, Steinbach LS, De Monaco D et al (2004) “Baby wrist”: MRI of an overuse syndrome in mothers. AJR Am J Roentgenol 182:719–724CrossRefPubMedGoogle Scholar
  7. 7.
    Kwon BC, Choi S-J, Koh SH et al (2010) Sonographic Identification of the intracompartmental septum in de Quervain’s disease. Clin Orthop 468:2129–2134CrossRefPubMedGoogle Scholar
  8. 8.
    Volpe A, Pavoni M, Marchetta A et al (2010) Ultrasound differentiation of two types of de Quervain’s disease: the role of retinaculum. Ann Rheum Dis 69:938–939CrossRefPubMedGoogle Scholar
  9. 9.
    Rousset P, Vuillemin-Bodaghi V, Laredo J-D, Parlier-Cuau C (2010) Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology 257:427–433CrossRefPubMedGoogle Scholar
  10. 10.
    Kutsumi K, Amadio PC, Zhao C et al (2005) Gliding resistance of the extensor pollicis brevis tendon and abductor pollicis longus tendon within the first dorsal compartment in fixed wrist positions. J Orthop Res Off Publ Orthop Res Soc 23:243–248CrossRefGoogle Scholar
  11. 11.
    Güleç A, Türkmen F, Toker S, Acar MA (2016) Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study. Plast Reconstr Surg Glob Open 4:e1022.  https://doi.org/10.1097/GOX.0000000000001022 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mahakkanukrauh P, Mahakkanukrauh C (2000) Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain’s disease. Clin Anat 13:195–198CrossRefPubMedGoogle Scholar
  13. 13.
    Nagaoka M, Matsuzaki H, Suzuki T (2000) Ultrasonographic examination of de Quervain’s disease. J Orthop Sci Off J Jpn Orthop Assoc 5:96–99Google Scholar
  14. 14.
    Daenen B, Houben G, Bauduin E et al (2004) Sonography in wrist tendon pathology. J Clin Ultrasound JCU 32:462–469CrossRefPubMedGoogle Scholar
  15. 15.
    Lane LB, Boretz RS, Stuchin SA (2001) Treatment of De Quervain’s Disease: Role of Conservative Management. J Hand Surg 26:258–260CrossRefGoogle Scholar
  16. 16.
    Woods TH (1964) de Quervain’s Disease: a plea for early operation. a report on 40 cases. Br J Surg 51:358–359CrossRefPubMedGoogle Scholar
  17. 17.
    Codega G (1987) Tecnica chirurgica nella malattia di de Quervain. Patol, PolsoGoogle Scholar
  18. 18.
    Kapandji AI (1990) Enlargement plasty of the radio-styloid tunnel in the treatment of De Quervain tenosynovitis. Ann Chir Main Memb Superieur Organe Off Soc Chir Main Ann Hand Up Limb Surg 9:42–46CrossRefGoogle Scholar
  19. 19.
    Le Viet D, Lantieri L (1992) De Quervain’s tenosynovitis. Transversal scar and fixation of the capsular flap. Rev Chir Orthop Reparatrice Appar Mot 78:101–106PubMedGoogle Scholar
  20. 20.
    Bakhach J, Sentucq-Rigal J, Mouton P et al (2005) The Omega “Omega” pulley plasty. A new technique to increase the diameter of the annular flexor digital pulleys. Ann Chir Plast Esthet 50:705–714CrossRefPubMedGoogle Scholar
  21. 21.
    Yuasa K, Kiyoshige Y (1998) Limited surgical treatment of de quervain’s disease: Decompression of only the extensor pollicis brevis subcompartment. J Hand Surg 23:840–843CrossRefGoogle Scholar
  22. 22.
    White GM, Weiland AJ (1984) Symptomatic palmar tendon subluxation after surgical release for de Quervain’s disease: a case report. J Hand Surg 9:704–706CrossRefGoogle Scholar
  23. 23.
    Sakai N (2002) Selective corticosteroid injection into the extensor pollicis brevis tenosynovium for de Quervain’s disease. Orthopedics 25:68–70PubMedGoogle Scholar
  24. 24.
    Sawaizumi T, Nanno M, Ito H (2007) De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop 31:265–268CrossRefPubMedGoogle Scholar
  25. 25.
    Zingas C, Failla JM, Van Holsbeeck M (1998) Injection accuracy and clinical relief of de Quervain’s tendinitis. J Hand Surg 23:89–96CrossRefGoogle Scholar
  26. 26.
    Harvey FJ, Harvey PM, Horsley MW (1990) De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg 15:83–87CrossRefGoogle Scholar
  27. 27.
    Peck E, Ely E (2013) Successful treatment of de Quervain tenosynovitis with ultrasound-guided percutaneous needle tenotomy and platelet-rich plasma injection: a case presentation. PM R 5:438–441. dCrossRefPubMedGoogle Scholar
  28. 28.
    Lapègue F, André A, Meyrignac O et al (2016) US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology 280:493–499CrossRefPubMedGoogle Scholar
  29. 29.
    Rajeswaran G, Lee JC, Eckersley R et al (2009) Ultrasound-guided percutaneous release of the annular pulley in trigger digit. Eur Radiol 19:2232–2237CrossRefPubMedGoogle Scholar
  30. 30.
    Zhao J-G, Kan S-L, Zhao L et al (2014) Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence. J Hand Surg 39:2192–2202CrossRefGoogle Scholar
  31. 31.
    Jou IM, Chern TC (2006) Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit. J Hand Surg Edinb Scotl 31:191–199CrossRefGoogle Scholar
  32. 32.
    Anderson BC, Manthey R, Brouns MC (1991) Treatment of De Quervain’s tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum 34:793–798CrossRefPubMedGoogle Scholar
  33. 33.
    Mirzanli C, Ozturk K, Esenyel CZ et al (2012) Accuracy of intrasheath injection techniques for de Quervain’s disease: a cadaveric study. J Hand Surg Eur Vol 37:155–160CrossRefPubMedGoogle Scholar
  34. 34.
    Mellor SJ, Ferris BD (2000) Complications of a simple procedure: de Quervain’s disease revisited. Int J Clin Pract 54:76–77PubMedGoogle Scholar
  35. 35.
    Kazmers NH, Liu TC, Gordon JA et al (2017) Patient- and Disease-Specific Factors Associated With Operative Management of de Quervain Tendinopathy. J Hand Surg.  https://doi.org/10.1016/j.jhsa.2017.07.017

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Franck Lapègue
    • 1
    • 2
  • Aymeric André
    • 3
    • 4
  • Etienne Pasquier Bernachot
    • 1
  • Ezin Jocelyn Akakpo
    • 5
  • Pierre Laumonerie
    • 3
    • 6
  • Hélène Chiavassa-Gandois
    • 1
  • Omar Lasfar
    • 1
  • Christophe Borel
    • 1
  • Marine Brunet
    • 1
  • Olivia Constans
    • 1
  • Hubert Basselerie
    • 1
  • Nicolas Sans
    • 1
  • Marie Faruch-Bilfeld
    • 1
  1. 1.Service d’imagerie, CHU de Toulouse- Purpan, bâtiment Pierre Paul RiquetToulouse cedex 9France
  2. 2.ELSAN, Polyclinique Le LanguedocNarbonneFrance
  3. 3.Laboratoire d’anatomie, faculté de médicineToulouseFrance
  4. 4.Service de chirurgie orthopédique, clinique Médipole GaronneToulouse Cédex1France
  5. 5.ISBA, Faculté de médecine du CNHU de CotonouCotonouBénin
  6. 6.Institut de l’appareil locomoteur, CHU de Toulouse- Purpan, bâtiment Pierre Paul RiquetToulouse cedex 9France

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