Ultrasound-Guided de Quervain's Tendon Release, Feasibility, and First Outcomes

Abstract

Background de Quervain's syndrome is one of the main tendonitis of the wrist. The hypothesis of authors was that de Quervain's syndrome could be successfully treated with a specific ultrasound-guided percutaneous procedure, as it is for trigger finger. Surgical Technique Identification of the subcompartmentalization of the first extensor compartment was performed first, using the Hiranuma's classification, prior to the surgery. Then, we assessed precisely the positions of the sensory branches of the radial nerve and drew the landmarks. Through a continuous ultrasound in-plane control, we performed a percutaneous retrograde section of each part of the first compartment of the extensors, using a dedicated surgical blade. Methods In a cadaveric study, authors proposed to assess the feasibility and safety of a new and specific procedure and then assessed their first clinical cases. Fourteen specimen wrists were analyzed with ultrasound and the procedure was performed prior to an open control of the efficiency of the release, and safety for the superficial nerves. Then, we reported the results of the 22 first patients included in the clinical series. Results In a cadaver laboratory, authors were able to identify with ultrasound the type of first compartment septation (subcompartmentalization) in 13 cases (n = 14). The misidentification induced one incomplete release. No damages of the superficial radial nerve were observed despite close relationship. In the small series (n = 22), the duration of surgery was 8 minutes (range: 4–18 minutes). It was performed in office surgery and no morbidities were noticed. All patients improved, from quickDASH preoperative score of 59 (range: 28–71) to quichDASH postoperative score of 9 (range: 0–25). Conclusion Ultrasound-guided percutaneous release in the de Quervain's disease is a safe and reliable procedure without specific morbidity. Great care should be taken to avoid sensory nerve injuries and to identify the correct type of subcompartmentalization with a precise ultrasound evaluation.

The ultrasound-guided percutaneous release technique for De Quervain's disease using an acupotomy

“…We put forward a different point of view from other studies (9)(10)(11). Due to two volar bony ridges in the radial styloid process (24), the extensor retinaculum fixes the two tendons here, and the narrow area formed by the bony bulge and tendon sheath enlarges the stress of tendon.…”

“…Research demonstrates that the first annular pulley's percutaneous release procedures produce outcomes comparable to those of open surgery in the trigger finger (8). According to three studies, dQD may be treated efficiently and safely using percutaneous release technology (9)(10)(11).…”

Management of de Quervain Tenosynovitis

“…In the cadaveric portion, they found that successful complete release of the FDC was performed in 13 of 14 wrists, and the single case of incomplete release was in a wrist where a separate EPB subcompartment had not been identified on US; they found superficial tendon abrasions in some cases, but otherwise there were no injuries to the surrounding structures. In their case series, PNR was performed in the office, and they found decreased DASH scores at 1 month, with 19 of 22 patients returning to work by 3 months 67 . While some of the data reported in these studies are encouraging, higher-level studies regarding PNR are needed before this procedure should be considered a legitimate treatment option.…”

“…Their study also included a prospective case series of 35 patients who underwent PNR, and they found that 91.4% of patients had a negative Finkelstein test at 1 month, had marked improvements in outcome measures at up to 6 months following the procedure, and were able to avoid surgical release 66 . Croutzet et al also performed a cadaveric study that was followed by a prospective case series 67 . In the cadaveric portion, they found that successful complete release of the FDC was performed in 13 of 14 wrists, and the single case of incomplete release was in a wrist where a separate EPB subcompartment had not been identified on US; they found superficial tendon abrasions in some cases, but otherwise there were no injuries to the surrounding structures.…”

Ultrasound Imaging and Guidance in Common Wrist/Hand Pathologies

“…[60][61][62][63] Although studied in a small group of cadavers/patients, US-guided release in patients with DQD has been reported as a safe and reliable procedure, without any specific morbidity. 64…”