Accuracy of Injection Into the First Dorsal Compartment: A Cadaveric Ultrasound Study

Abstract

Ultrasound is unlikely to increase the accuracy of injections into an unseptated FDC. It may aid in injection of a septated FDC; however, that remains to be statistically demonstrated.

Utility of Ultrasonography and Significance of Surgical Anatomy in the Management of de Quervain Disease: A Systematic Review and Meta-Analysis

“…After cutaneous penetration, the needle is directed parallel to the forearm beneath the extensor retinaculum and the injectate is delivered. 13 In the present study, the authors demonstrated that ultrasound-guided steroid injections conferred significantly better outcomes over manual injection techniques, both in terms of injection accuracy as assessed by anatomical studies, 14,21,22 and clinical cure rates. 26,[39][40][41][42][43][44][45] In a study directly comparing both approaches, a 91 percent clinical success rate, defined as the avoidance of surgery, was reported for the ultrasound-guided injection group and a 59 percent success rate was reported for the manual injection group.…”

De Quervain’s tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release

“…In the presence of a septum, the USG group achieved a higher infiltration rate in EPB sub-compartments of 75% accuracy in reaching the sub-compartment when compared to 33% in AL. Although statistically unconfirmed, they stated that USG aided injections in the presence of a septum [32]. In our series, more than 50% of patients had a separate sub-compartment and none of them came back with recurrence of symptoms, suggesting the effectiveness of USG guided injections.…”

“…Another study, by Kang et al in a series of 15 fresh cadavers, demonstrated not only a higher accuracy for USG guided injections (93.3% vs. 40%) to target the first extensor compartment but also better results when separate septum was present (85.7% vs. 16.7%) [30]. In a cadaver model involving 43 specimens comparing USG and anatomical landmark (AL) guided injection, Kutsikovich et al showed that both techniques had an infiltration rate of 100% [32]. In the presence of a septum, the USG group achieved a higher infiltration rate in EPB sub-compartments of 75% accuracy in reaching the sub-compartment when compared to 33% in AL.…”

“…Their results suggested that USG guided injections targeted the septation of EPB better than the blind injections [19]. However, there have been reports which have questioned the advantage of the use of USG including those with reports of increased chance of failure particularly with the presence of a sub-compartment [16,23,31,32]. Nevertheless, its benefit and use are still advocated in view of a higher chance of placement of the needle at the pathological site [23,31,32].…”

“…However, there have been reports which have questioned the advantage of the use of USG including those with reports of increased chance of failure particularly with the presence of a sub-compartment [16,23,31,32]. Nevertheless, its benefit and use are still advocated in view of a higher chance of placement of the needle at the pathological site [23,31,32]. In a level 1, study of randomized comparison between blind and USG guided injection involving 44 patients, Shin et al observed sustained improvement in PRWE and pain scores at 4 and 12 weeks post-injection [16].…”