gms | German Medical Science

62. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

06. bis 08. Oktober 2022, Garmisch-Partenkirchen

A tailored approach to treatment of de Quervain's disease: therapeutic options and surgical approach based on anatomical characteristics

Meeting Abstract

  • corresponding author presenting/speaker Maria Ferrando Fons - Fachklinik 360 grad, Ratingen, Germany
  • María Pilar Aparisi Gomez - Departmen of Radiology IMSKE, Valencia, Spain
  • Alberto Bazzocchi - Radiology in IRCC Istituto ortopedico Rizzoli, Bologna, Italy

Deutsche Gesellschaft für Handchirurgie. 62. Kongress der Deutschen Gesellschaft für Handchirurgie. Garmisch-Partenkirchen, 06.-08.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22dgh54

doi: 10.3205/22dgh54, urn:nbn:de:0183-22dgh545

Published: October 6, 2022

© 2022 Ferrando Fons et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.