Ultrasound-guided de Quervain tendon release: Feasibility study and preliminary clinical results

Abstract

Background De Quervain's syndrome is one of the main tendonitis of the wrist. The hypothesis of authors was the de Quervain's syndrome could be successfully treated with a specific ultrasound-guided percutaneous procedure, as it is for trigger finger. Surgical technique identification of the sub-compartimentalisation of the first extensor compartment was performed first using the Hiranuma classification prior to the surgery. Then, through a continuous ultrasound in-plane control, we performed a percutaneous retrograde section of each part of the first compartment of the extensor. Methods and technique In a cadaveric study, authors proposed to assess the feasibility and safety of a new and specific procedure to perform an ultasound-guided percutaneous release for de Quervain's syndrome and then assessed their preliminary clinical results. Fourteen specimen wrists were analysed with ultrasound and the procedure was performed prior to an open control of the efficiency of the release and safety for the superficial nerves. Then, we reported our results concerning the three first patients included in the prospective clinical series. Results In cadaver lab, authors were able to identify with ultrasound the type of first compartment septation (sub-compartimentalization) in 13 cases ( n = 14). The misidentification induced one incomplete release. No damages of the superficial radial nerve were observed despite close relationship. In the preliminary clinical series, the duration of surgery was 10 min (5–18) and no kind of morbidities was noticed. Conclusion Ultrasound-guided percutaneous release in the de Quervain's disease is a safe and reliable procedure without specific morbidity but many care should be taken to avoid superficial nerves and to identify with ultrasound the correct type of sub-compartimentalization prior to the surgery.