De Quervain's Disease Research Articles

Tendon injections - upper extremity.

Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.

Linear Hypopigmentation on the Right Arm.

A 73-year-old woman presented to the dermatology clinic with hypopigmentation along the right arm. Her medical history was notable for prior treatment with intralesional triamcinolone injections for De Quervain tenosynovitis.

A Retrospective Case Series Study on a Minimally Invasive Ultrasound-Guided First Dorsal Compartment Release Technique for Refractory De Quervain Tenosynovitis.

The aim of this study was to evaluate the outcomes of patients treated with a novel minimally invasive complete release of the first dorsal compartment percutaneously under ultrasound guidance using an 18-gauge needle with an 18 blade at the tip. This was a retrospective case series. Nine adults (ten wrists) were included in the study of this technique. All patients had failed conservative care and had tenderness to palpation over the first dorsal compartment, a positive Finklestein test, and confirmed tenosynovitis with ultrasound imaging before the procedure. The main outcome measures were reduction in pain as determined by the numeric rating scale and improvement of function determined by the Nirschl Phase scale at both short- and long-term follow-up. There was 100% follow-up, with mean (SD) follow-up occurring at 23.1 (9.8) mos (range, 9-42 mos). From preprocedure to follow-up, numeric rating scale pain decreased from 4.1 (SD, 2.5) to 0.0 (SD, 0.0) ( P < 0.001), and Nirschl phase improved from 2.5 (SD, 1.9) to 0.2 (SD, 0.4) ( P = 0.03). No patients required revision open-release surgery or suffered neurovascular complications. This technique resulted in significant improvement of pain and function for all patients and no short- or long-term neurovascular complications were seen.

Reliability of Extensor Pollicis Brevis (EPB) Entrapment Test in Identifying a Separate Compartment for EPB in Patients with de Quervain Disease.

Background: The presence of a separate compartment for the extensor pollicis brevis tendon (EPB) has an implication in the treatment outcome for de Quervain disease. The EPB entrapment test, proposed by Alexander and colleagues, claims to correlate with the presence of a separate compartment for EPB. The purpose of our study is to evaluate the reliability of the EPB entrapment test in predicting a separate compartment for EPB in patients with de Quervain disease. Methods: This was a prospective observational study involving 50 consecutive patients who underwent de Quervain release by a single surgeon. Preoperatively, EPB entrapment test was performed by the operating surgeon. The outcome of the test was recorded and the presence of a separate compartment for the EPB was determined during surgery. Sensitivity, specificity, positive predictive value and negative predictive value of the EPB entrapment test was determined. Results: EPB entrapment test was positive in 28 of 50 patients. In 21 of them, a separate compartment for the EPB was noted. The positive predictive value of the test was found to be 75.8%. The test had a false positive rate of 26.9%, a false negative rate of 12.5%, sensitivity of 87.5% and specificity of 73%. There is a significant association between a positive EPB entrapment test and the presence of a separate compartment for the EPB (p value <0.001). The sensitivity of the test increases to 95.8% if pain on both extension and abduction of the thumb is considered a positive response. Conclusions: The EPB entrapment test is a reliable clinical test to look for the presence of a separate compartment for EPB. Considering the response of pain on both extension and abduction of the thumb further improves the sensitivity of the test. Hence, we suggest including this response also as a positive test. Level of Evidence: Level II (Diagnostic).

Osteoid Osteoma of Scaphoid Treated with Radiofrequency Ablation

Osteoid osteoma is one of the commonest benign bone tumour of adolescence. Diagnosis is based upon the typical clinical features, site of occurrence and imaging findings. Occurrence of this lesion in an atypical site is associated with delay in diagnosis and challenges in management. We present a rare case of osteoid osteoma in scaphoid in a 14-year-old girl. Comprehensive work-up using radiograph, computerized tomography (CT), magnetic resonance imaging and Tc99-multidetector methylene diphosphonate (MDP) bone scan was used to make the correct diagnosis over other conditions with similar presentation like de Quervain tenosynovitis, intersection syndrome and inflammatory arthropathies. We also describe the treatment using CT-guided percutaneous radiofrequency ablation of this lesion and a brief literature review regarding the incidence of this lesion and treatment options available. Level of Evidence: Level V (Therapeutic).

Time to Reconsider Occupation Induced De Quervain's Tenosynovitis: An Updated Review of Risk Factors.

De Quervain's tenosynovitis (DQT) is described to be an attritional and degenerative process, triggered by stenosing inflammation of the tendon sheath in the first dorsal compartment of the wrist. Understanding and targeting the risk factors associated with DQT will help clinicians and patients to reduce its prevalence. This review aims to evaluate the current literature surrounding the risk factors which were divided into the anatomical, patient, and occupational factors associated with the condition. The two main anatomical variations associated with DQT are subcomparmentalization and multiple tendon slips of the abductor pollicus longus (APL) and extensor pollicus brevis (EPB) tendons. DQT is more common in females and is often noted in pregnancy and the postpartum period. When considering occupational factors, work-related activity has not been shown to be a direct cause of DQT, despite leading organisations supporting the converse.

Comparative study between corticosteroids and platelet-rich plasma in the treatment of de Quervain’s tenosynovitis

Background: De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition that involves tendon entrapment affecting the first dorsal compartment of the wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist. De Quervain tendinopathy can be self-limited and may resolve without intervention. For those individuals with persistent symptoms splinting, systemic inflammatories, and corticosteroid injections are frequently used as non-surgical treatment options. Corticosteroids have both anti-inflammatory and immunosuppressive effects and have been used in the treatment of DQST. With the widespread increase in research in the field of regenerative orthopedics, PRP has become a natural, biological enhancer. Platelet-rich plasma (PRP) is safe and reduces symptoms in different tendon pathologies, such as De Quervain's disease. It has a high concentration of platelets above baseline in comparison to whole blood count to accelerate tissue healing, modulate inflammation, and provide symptomatic relief. Aim: To evaluate the effectiveness of PRP injection in comparison to corticosteroid injection in the treatment of DQST. Methods: Patients underwent randomization into groups: corticosteroids and PRP. We followed both groups at 4, 12, and 24 weeks for improvement in wrist pain, disability, and finger motion. The resolution of symptoms and improvements in the Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed to evaluate treatment success. Results: 1) Forty-four patients with suspected DQST were divided into two groups, i.e., PRP group I and corticosteroid group II in a 1:1 by lottery method. 2) Pain measured by VAS score has shown a reduction in pain in the PRP group-I with every follow-up. However, a similar pattern was not shown in the corticosteroid group II. We found in our study that a lower DASH score was found in 14(63.64%) patients of PRP group I compared to 8(36.36%) patients of corticosteroid group II. After PRP injection, pain, disability, and finger motion improve steadily and eventually get better. Conclusions: Based on results found in the present study, for De Quervain's Tenosynovitis (DQST) condition, PRP injections were superior to corticosteroid injections in terms of pain management, finger motion, and reduced disability.

Prevalence of Septated First Dorsal Compartment Among Iranian Patients with De Quervain Tenosynovitis

Background: A septum in the first extensor compartment and variation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons affect the development and treatment of the de Quervain disease. This study aimed to determine the prevalence of septum and the number of APL and EPB tendons in Iranian surgical de Quervain patients. Methods: In this case series, we evaluated 37 consecutive wrists from September 2019 to April 2020 that were evaluated and surgically explored by the same senior surgeon; and the number of tendons and the existence of septum were recorded. Results: Patients were mainly women (24 [67.6%]), and the mean age was 50.43 ± 16.42 years. Seven (18.9%) patients had one, 23 (62.2%) had two, and 7 (18.9%) patients had three APL tendons. All patients had EPB tendons, 34 (91.9%) had 1 EPB tendon, and 3 (8.1%) had 2 EPB tendons. A septum was observed in 23 (62.2%) patients. Conclusion: The most functional variation in Iranian patients consists of 2 APL tendons and 1 EPB tendon. Also, most affected wrists had a septum in the first extensor compartment.

Prevalence of De Quervain disease in infant caregivers and its association with risk factors.

De Quervain's disease (DQD) is commonly reported in mothers during pregnancy up to delayed postpartum period. A cross-sectional study was conducted to assess infant caregivers who visited the paediatric outpatient department or vaccination centre in two hospitals of Lahore, during the months of May and June, 2021. A total of 190 subjects were interviewed directly and assessed by applying Finkelstein's test on both hands. Data was collected using Numeric Pain Rating Scale (NPRS) and Patient Rated Wrist Evaluation (PRWE) from positive subjects. They were asked to report their pain and difficulty level of the affected hand with worsened symptoms. The results exhibited 26.8% prevalence of DQD in a sample size of 190. Infant's age, lifting frequency and hand dominance were proved significant risk factors. However, caregiver's age, history of wrist pain, infant weight and relationship with infant were proved insignificant. Mean PRWE pain and functional scores were 23.14±7.72 and 18.53±6.09, respectively.

Acupuncture for de Quervain's tenosynovitis: A randomized controlled trial

BackgroundAcupuncture has been an alternative approach for de Quervain's tenosynovitis (DQt), but trial evidence is still lacking. PurposeThis study aimed to assess the efficacy of acupuncture in patients with DQt. Study DesignA randomized controlled trial. MethodsA total of 68 subjects with DQt were recruited from outpatients of Department of Orthopaedics and Traumatology, and Chinese medicine clinics, The University of Hong Kong, and were randomized into the acupuncture group (n = 34) and the waitlist group (n = 34). Subjects in the acupuncture group received 5 acupuncture sessions over 2 weeks, followed by a 10-week follow-up. The waitlist control group received assessments only in the first 6 weeks of the waiting period and received the same acupuncture treatment and follow-up as the treatment group in the next 12 weeks. The primary outcome was the general pain intensity using the Visual Analogue Scale (VAS) at the end of treatment (week 2). Secondary outcomes were grip and pinch strengths of affected hands, the quick Disabilities of the Arm, Shoulder and Hand Score (Q-DASH), and the World Health Organization Quality of Life-brief Questionnaire (WHOQOL-BREF) at weeks 2 and 6. ResultsFrom baseline to 2 weeks, the mean VAS score decreased by 19.5 points in the acupuncture group and by 3.4 points in the waitlist group. The difference for acupuncture vs waitlist control was -16.2 points (95% CI, -26.7 to -5.6, p = 0.003). Acupuncture effects sustained for 10 weeks (mean difference compared with baseline, -30.6; 95% CI, -39.6 to -21.7). Secondary outcomes showed that acupuncture reduced pain intensity, improved grip and pinch strength of affected hands, and Q-DASH scores, but not the scores of WHOQOL-BREF in patients. No serious adverse event occurred during the study period. ConclusionsOur findings support that 2-week of acupuncture is safe and effective in the reduction of pain intensity, and improvement of strengths and disabilities of hand in DQt patients. Acupuncture also has long-term effects on DQt. Trial registrationThis study was registered at clinicaltrials.gov (NCT03472443).

DELINEATION OF DE QUERVAIN TENOSYNOVITIS IN SAUDI ARABIA AND LITERATURE REVIEW

Background: De Quervain Tenosynovitis was first reported in the literature in 1895 by Fritz De Quervain, describing entrapment tendinitis of the first dorsal compartment of the wrist. This study conducted to evaluate our institutions experience with De Quervain Tenosynovitis patients Methods :Retrospective cross-sectional hospital based study conducted at King Abdul-Aziz Medical City a tertiary care center in Riyadh.The study included all De Quervain Tenosynovitis cases treated in our institution between January 2008 and December 2014. Results: The study included 29 patients. Mean (Interquartile range) age was 42 (24-78) years and 19/29 (66%) were female. Mean (Interquartile range) BMI at the diagnosis was 30 (21-42). The most common radiological finding was distal radius cortical ridging17/29 (59%). Conservative treatment was initiated in 17/29 patients (59%), yet no clinical improvement noted and all the cases required surgical intervention 29/29 (100%). The intraoperative septum was observed in all cases 29/29 (100%). Conclusion: Routine wrist X-rays in DeQuervain Tenosynovitis is cost-effective and should be considered to guide the treatment course with low threshold for surgical intervention might be warranted particularly in obese female patient.

Patterns of Involvement of Digits in Patients with Multiple Trigger Digits: A Retrospective Study.

Background: The involvement of digits in patients with multiple trigger digits often displays specific patterns. We aimed to determine the patterns of involvement of digits in multiple trigger digits and their association with patient-related factors and compare them to those of patients with a single trigger digit. Methods: All patients with trigger digits treated over a 2-year period were retrospectively examined in June 2020. Data regarding the age at occurrence of initial trigger digit, sex, occupation, presence of diabetes mellitus, carpal tunnel syndrome and de Quervain disease, and hand dominance was determined. The data obtained from patients with multiple trigger digits was compared with those with a single trigger digit. Additionally, we investigated the patterns of involvement of the first two affected digits in patients with multiple trigger digits and their association with patient-related factors and compared them to those in patients with a single trigger digit. Results: Three hundred and eighty-seven and 577 patients with multiple and single trigger digits, respectively, were studied. Their median age was 60 (range: 17-92) years. The incidence of concomitant diabetes mellitus was 150% higher in patients with multiple trigger digits than in those with a single trigger digit. Symmetric occurrence and adjacent occurrence patterns were observed in 42.4 % and 28.4% of the 387 patients, respectively. Initial onset in the fifth and sixth decades of life, female sex and a time lag between occurrences were significantly associated with symmetric occurrence. Male sex and simultaneous occurrence in two digits were significantly associated with adjacent occurrence. Diabetes mellitus was not associated with each occurrence pattern. Conclusions: We have confirmed the presence of two involvement patterns in patients with multiple trigger digits: symmetric and adjacent. Our data will help in the prevention, early detection and management of multiple trigger digits. Level of Evidence: Level III (Therapeutic).

Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis

We sought to determine the effectiveness of corticosteroid injections (CSIs) for de Quervain tenosynovitis in patients with diabetes mellitus. We retrospectively identified all patients with diabetes receiving a CSI for de Quervain tenosynovitis by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, number and timing of CSIs, and first dorsal compartment release. Success was defined as not undergoing an additional CSI or surgical intervention. The mixture of a corticosteroid and local anesthetic provided in each injection was at the discretion of each individual surgeon. Corticosteroid injections were given to 169 wrists in 169 patients with diabetes. Out of 169 patients, 83 (49%) had success following the initial CSI, 44 (66%) following a second CSI, and 6 (67%) following a third CSI. A statistically significant difference was identified in the success rates between the first and second CSIs. Ultimately, 36 of 169 wrists (21%) underwent a first dorsal compartment release. Patients with diabetes mellitus have a decreased probability of success following a single CSI for de Quervain tenosynovitis in comparison to nondiabetic patients, as described in the literature. However, the effectiveness of each additional CSI does not appear to diminish. Therapeutic IV.

Triggering Thumb Is Not Always a Trigger Thumb

Although rare, the thumb can trigger because of de Quervain disease. An 18-year-old woman presented with painful triggering during thumb movements. Physical examination revealed locking upon thumb extension and painful snapping upon thumb flexion, with tenderness over the first extensor compartment. During the ultrasonography examination, the extensor pollicis brevis tendon snapped with a jerky movement. According to intraoperative active movement under wide-awake local anesthesia no tourniquet, only the extensor pollicis brevis tendon subcompartment was released, and the snapping was resolved. The patient was symptom-free at the second postoperative week control. Triggering because of de Quervain tenosynovitis is a rare condition, and surgical release is required in most cases. Dynamic ultrasonography is an effective tool for precise preoperative assessment of pathology and assists surgical planning. Surgery under wide-awake local anesthesia no tourniquet is advised, which helps intraoperative assessment of pathology and ensures accurate treatment.

Pulley Reconstruction Following Surgical Release of DC1 Pulley in De Quervain's Tenosynovitis: Surgical Technique and Case Series.

De Quervain's disease (DQD) is tenosynovitis of the first dorsal compartment (DC1) of the wrist between the osteofibrous tunnel and the tendons involving the APL and EPB sheaths at the radial styloid. Surgical intervention is indicated when pain does not resolve despite 3 to 6 months of conservative management. Release of the first dorsal compartment is an effective treatment of DQD. In addition to surgical release, we performed pulley reconstruction using a new technique in the present series of 20 patients which has not been previously described with a followup of over 1 year. All patients showed a consistent improvement in VAS score at over one year followup with resolution of Finkelstein, Eichoff and WHAT test. Only one temporary neuropraxia was encountered due to stretching/scar entrapment of superficial branch of radial nerve. Our innovative technique of pulley reconstruction is not only easy to understand and perform but has shown consistent result in the 20 cases operated with this technique with a follow up of at least 1 year. The technique has the distinct advantage of having a quick learning curve and gives reliable, lasting results without complications or recurrence.

An intraarticular injection to the elbow joint completely relieves pain in stenosing tenosynovitis of the wrist

Stenosing tenosynovitis of the first dorsal compartment of the wrist, de Quervain’s disease causes radial wrist pain and disability. Clinically, corticosteroids are most commonly used to treat de Quervain's disease. The injection of triamcinolone into the sheath of both the extensor pollicis brevis and abductor pollicis longus tendon is known to successfully relieve the symptoms of de Quervain’s disease. However, depigmentation of the skin and spontaneous rupture of extensor tendons have been frequently reported as side effects of injection of intra-sheath injection of triamcinolone. To bypass undesirous complications of triamcinolone for the treatment of de Quervain’s disease, we conducted an intra-articular injection of it into the elbow joint instead of an intra-sheath injection to the wrist. This retrospective study examines the results of 54 outpatients who presented with de Quervain’s disease from October 2018 through September 2021 and were treated with a combination of triamcinolone/ lidocaine injection. After single injection of triamcinolone, patients had a considerable pain relief with a dose-dependent manner and experienced an easier wrist mobility than prior to the treatment. With two times of injections, pain relief and movement flexibility were more consolidated. Adverse complications caused by the intra-articular triamcinolone were observed in none. These results indicate that the intra-articular triamcinolone in the elbow joint can provide an acceptable treatment option for de Quervain’s disease.

Efficacy of therapeutic ultrasound in De-Quervain' s Tenosynovitis

Overuse or repetitive motion can develop De-syndrome, Quervain's which produces pain along the thumb side of the wrist. The thumb tendons get irritated or inflamed as a result of these motions. Activities that involve regular side-to-side extension of the thumb or wrist might trigger De Quervain's tenosynovitis. Objective: To assess the efficacy of therapeutic ultrasound in De-Quervain's Tenosynovitis. Methods: In this study, forty people were separated into two groups: interventional and control groups, each with 20 people. Results: The interventional group's mean age was 37.70 with a standard deviation of 7.921, while the control group's mean age was 36.60 with a standard deviation of 7.816. Out of 20 individuals in the intervention group, 10 were male and 10 were female, whereas in the control group, 11 were male and 9 were female. The interventional group's mean height and weight were 1.642m0.1740 and 75.9515.830, respectively, while the control group's mean height and weight were 1.675m01517 and 75.5013.296. Out of the 20 patients in the interventional group, one was underweight, seven were normal weight, four were overweight, and eight were obese. Eight patients in the control group were of normal weight, seven were overweight, and five were obese. Conclusions: It was determined that ultrasonic therapy is useful in treating De-tenosynovitis quervain's when the tendon is inflamed

Biomechanical assessment of the first dorsal compartment of the wrist: A fresh cadaver study with relevance to de Quervain's disease.

Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment. This study aimed to investigate the relationship between intertendinous septum's presence or absence, internal pressure and wrist positon in the first compartment. Fourteen arms were obtained from seven fresh frozen cadavers. A pressure sensor was inserted into the first compartment; if a septum was present, the pressure sensor was inserted into the abductor pollicis longus (APL) side and the extensor pollicis brevis (EPB) side, respectively. Three wrist positions were also tested: neutral, 45° flexion, and 45° extension. Intertendinous septa were present in seven wrists. The average pressure change in the first compartment measured on the EPB side of a present septum was significantly greater than that measured on the APL side of a present septum or where no septum existed: no septum=54.6 ± 48.3kPa; septum, EPB=81.7 ± 76.5kPa; and septum, APL=32.8 ± 37.4kPa. The average pressure change was also significantly greater in the flexion wrist position relative to the neutral and extension positions: neutral=36.3 ± 58.0kPa; 45° flexion=79.5 ± 65.9kPa; and 45° extension=50.4 ± 42.6kPa. Clear relationships existed between (1) the presence of a septum and increased internal pressure on the EPB side in the first compartment and (2) increased internal pressure with the wrist at 45° flexion compared with the neutral and extension position.

Exercise after pregnancy

Exercise is a critical protective factor for most chronic medical conditions and is strongly recommended during pregnancy and the postpartum period. The preventive health effect of exercise status (versus non-exercise) is similar to the effect of being a non-smoker (versus smoker). This makes lifelong exercise habits for the population critical for public health. Childbirth is a traumatic process (whether vaginal or by Caesarean section) that temporarily prevents usual exercise postpartum. The aim of this article is to describe the return to normal exercise in the months postpartum, including the additional challenge of commencing good exercise habits for those new mothers who were not regular exercisers before childbirth. Pelvic issues, regardless of mode ofdelivery, affect return to exercise postpartum. Development of musculoskeletal injuries is also a significant risk, for example De Quervain's tenosynovitis from new activities such as changing, bathing and nursing. Hormonal and postural changes, extra body weight and support networks all affect successful return to exercise.

PENYULUHAN DAN PELATIHAN FISIOTERAPI PADA KONDISI DE’QUERVAIN SYNDROME DENGAN TERAPI LATIHAN DI KOMUNITAS KELUARGA DESA LESES SAWANGAN KECAMATAN GRINGSING KABUPATEN BATANG

&lt;p&gt;De Quervain syndrome is a disease with pain in the area of the styloideus process due to chronic inflammation of the tendon wrapping of the abductor polysis longus muscle and the extensor of the brevis polysis at the distal radius and the clamping of the two tendons. From the observation process of identifying physiotherapy problems in patients by lecturers and students of Physiotherapy, conducted by interviewing the community, it was found that the common problem experienced by patients was pain in the thumb. Situation analysis in the form of observations carried out by all teams in the family community, gringsing sub-district, Batang district in the form of interviews with the family community, the process of observing the identification of physiotherapy problems in De Quervain syndrome using lecture and question and answer methods, the purpose of this activity is to increase knowledge and understand the family community about the role of physiotherapy in patients, especially in reducing pain in the thumb. The solution offered by the team uses counseling and training methods to reduce pain in De Quervain syndrome with exercise therapy to increase muscle strength, the implementation of outreach activities is attended by ten family members, before the counseling and training process is given a pre-test and a post-test that is rejected. measure for people who understand the extension is carried out. The results of the pre-test and post-test proved that the level of understanding after counseling increased. It can be concluded that after being given counseling and physiotherapy training in De Quervain syndrome with exercise therapy in increasing muscle strength, there is an increase in muscle strength and the range of motion of the joints.&lt;/p&gt;&lt;strong&gt;Keywords&lt;/strong&gt;: De Quervain syndrome, exercise therapy