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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

  • Musculoskeletal
  • Published:
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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.

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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

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Funding

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

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Authors and Affiliations

  1. Service d’imagerie, CHU de Toulouse- Purpan, bâtiment Pierre Paul Riquet, Place du Dr Baylac, TSA, 40031-31059, Toulouse cedex 9, France

    Franck Lapègue, Etienne Pasquier Bernachot, Hélène Chiavassa-Gandois, Omar Lasfar, Christophe Borel, Marine Brunet, Olivia Constans, Hubert Basselerie, Nicolas Sans & Marie Faruch-Bilfeld

  2. ELSAN, Polyclinique Le Languedoc, Avenue de la Côte des Roses, 11100, Narbonne, France

    Franck Lapègue

  3. Laboratoire d’anatomie, faculté de médicine, 31062, Toulouse, France

    Aymeric André & Pierre Laumonerie

  4. Service de chirurgie orthopédique, clinique Médipole Garonne, 45 rue de Gironis, 31036, Toulouse Cédex1, France

    Aymeric André

  5. ISBA, Faculté de médecine du CNHU de Cotonou, Cotonou, Bénin

    Ezin Jocelyn Akakpo

  6. Institut de l’appareil locomoteur, CHU de Toulouse- Purpan, bâtiment Pierre Paul Riquet, Place du Dr Baylac, TSA, 40031-31059, Toulouse cedex 9, France

    Pierre Laumonerie

Authors
  1. Franck Lapègue
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  2. Aymeric André
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  3. Etienne Pasquier Bernachot
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  6. Hélène Chiavassa-Gandois
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  9. Marine Brunet
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  10. Olivia Constans
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Corresponding author

Correspondence to Franck Lapègue.

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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

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Lapègue, F., André, A., Pasquier Bernachot, E. et al. 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. Eur Radiol 28, 3977–3985 (2018). https://doi.org/10.1007/s00330-018-5387-1

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  • DOI: https://doi.org/10.1007/s00330-018-5387-1

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