Article
A tailored approach to treatment of de Quervain's disease: therapeutic options and surgical approach based on anatomical characteristics
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Published: | October 6, 2022 |
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Objectives: De Quervain disease is the second most common entrapment tendinopathy in the hand, usually occurring in middle-aged individuals, predominantly woman. It involves the first extensor compartment, containing the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) most at the level radial styloid. Several studies have suggested the presence of subcompartments and anatomical variation in the first extensor compartment may have an impact on treatment outcomes. Ultrasound, especially the use of high resolution transducers (17–18 MHz) has high sensitivity and specificity for the assessment of superficial structures and thus allows very accurate characterization of the anatomical variations, the degree of activity of inflammatory process, and the dynamic assessment and comparison with the contralateral side. Its low cost and availability make of ultrasound the ideal tool to investigate with De Quervain's disease.
The objectives of this poster are to illustrate the different anatomical configurations of the first extensor compartment, their appearances on ultrasound and correct diagnosis for the surgical approach.
Method: Pictorial review of anatomical variations and experience on management and outcome from our centers, as well as a review of the literature / current evidence.
Results: The presence of subcompartments and anatomical variation in the first extensor compartment may have an impact on procedure outcome. Subcompartments may have an impact on percutaneous procedure outcome, as injected solutions may not distribute evenly. Besides, surgery may be unsuccessful if all compartments are not adequately decompressed. Beyond clinical examination, ultrasound assessment allows to obtain correct description of the anatomy and the characterization of potential variants.
The standard ultrasound-guided treatment for De Quervain's disease is the injection of corticosteroids within the tendon sheath. Different corticosteroids may be used. Methylprednisolone acetate and triamcinolone are the most commonly used with local anaesthetics. The addition of hyaluronic acid seems to improve the outcome and to reduce recurrence rate.
Conclusion: A proper anatomical analysis and characterization of involvement of the extensors of the first compartment is essential for the correct approach to treatment of De Quervain's disease. Knowledge of the evidence of the benefits and safety of imaging-guided procedures and of technical tricks and tips are paramount to achieve good treatment outcomes.