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

Abstract

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. Design: 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. Results: 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. Conclusion:This technique resulted in significant improvement of pain and function for all patients and no short-or long-term neurovascular complications were seen.

Treatment of Chronic Extensor Carpi Ulnaris Stenosing Tenosynovitis Using Ultrasound-Guided Retinaculum Release

“…Because all the soft tissue layers can be visualized with live ultrasound imaging (i.e., the overlying soft tissue, the extensor retinaculum, the tendon sheath, and the tendon), there is no need to do a retraction of the overlying layers, which is hypothetically the main reason why the ECU tendon may have instability after the subsheath release. There have been no cases reported in the literature of tendon instability in research studies looking at the use of this ultrasound-guided technique for completing A1 pulley release for trigger fingers and first dorsal compartment release for De Quervain tenosynovitis 4,5,10,11 .…”

“…He was offered an experimental procedure-an ultrasoundguided percutaneous release of the ECU tendon using an 18-gauge needle with a blade at the tip. A similar procedure had been described by Colberg et al for the successful treatment of chronic De Quervain tenosynovitis 4,5 . The patient was educated about the risk of infection, bleeding, injury to the tendon or neurovascular structures, and instability of the ECU tendon after the release.…”

Ultrasound-guided surgery in musculoskeletal medicine

“…2. The number of the previous reports on USguided release/cutting is by far larger than those of other US-guided surgeries, which include carpal tunnel release [11,12], A1 pulley release in the treatment of trigger finger [13,14], first dorsal compartment release for de Quervan tenosynovitis [15], gastrocnemius release [16], plantar fascia release [17], etc. 3.…”