Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis?

Abstract

Background The routine use of plain radiography represents a significant expenditure and has been proven unnecessary in several orthopedic conditions. The utility of plain radiographs in the diagnosis of De Quervain's tenosynovitis (DeQ) is not clear. Questions/Purpose This study evaluates whether plain radiographic findings routinely predict the need for surgery or alter treatment courses in the initial diagnosis of DeQ. Patients and Methods A total of 200 patients who received wrist X-rays and had a diagnosis of DeQ were retrospectively selected at random. Their images were evaluated for relevant findings, including radial styloid abnormalities, arthritis, and tendon calcification. A chart review was performed to determine whether these X-rays altered the treatment courses. Results Of the 200 patients, 141 (69.1%) cases had at least one positive radiographic finding. Carpometacarpal joint (CMC) arthritis was the most common finding, seen in 63 (30.9%) cases. Of all patients, 141 (69.1%) were treated with corticosteroid injection only, 54 (26.5%) with corticosteroid injection and ultimately surgery, and 9 (4.4%) with surgery alone. There were no significant differences in the rates of surgery with positive X-ray findings. There were no cases in which radiographic findings resulted in a change in management, per the report of the treating physician. Conclusions Despite the high proportion of positive findings on X-ray, no radiographic findings altered the course of treatment in patients with isolated DeQ. Obtaining plain radiographs for isolated DeQ represents a significant cost and should be reserved for cases in which the results are preemptively deemed likely to influence the treatment course. Level of Evidence This is a level IV study.

Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis

“…It is possible that DeQ patients experience focal swelling at the radial side compared with the potential of generalized edema for CTS patients. [10][11][12] However, we found that the ratio of radiographic wrist edema is significantly larger in patients with DeQ compared with those with CMC and/or CTS. Furthermore, all radiographic measurements showed strong agreement for inter-and intraobserver reliabilities with the exception of the radialsided swelling, which only showed moderate agreement in the CMC group.…”

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

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