To study the role of ultrasonography in diagnosis, management and prevention of incomplete surgical release in patient’s of de Quervain’s disease

Author(s): Dr. Tilak Rommel Pinto, Dr. Harsharaj K, Dr. Anston Vernon Braggs, Dr. Mohan Kumar CR

Abstract: Background: Fritz de Quervain, in 1895, described the tenosynovitis of first extensor compartment tendons of abductor pollicis longus and extensor pollicis brevis. Clinically characterized by pain and swelling over the radial styloid process, a positive finkelstein test and accompanied by a palpable thickening of the tendon sheaths and painful wrist and thumb movements. The diagnosis is usually clinical and the treatment varies from conservative to surgical decompression of the first extensor compartment.
Materials and Methods: This is a prospective study of 28 patients of de Quervain’s tenosynovitis involving 30 wrists treated in Father Muller Medical College and Hospital, Mangalore between 1 September 2015 and 30 November 2016.
Results: A total of 28 patients and 30 wrists were examined in this study. The disease was found to be more common in fourth and fifth decade of life. In our study there were 23 females out of total 28 patients. Right wrist was more commonly affected than the left. Out of 28 patients 18 underwent surgery. Total 20 wrists out of 30 were surgically decompressed. Ultra sound showed the presence of single tendon of APL in 16 wrists (53.3%) and more than 1 tendon in 14 cases (46.7%). Out of 20 wrists which were operated 12 had 2 slips of APL and 8 had one slip of APL. Ultrasonography correctly identified the number of tendons in all except one case, in which it under diagnosed the number of tendons.
Conclusion: Though ultrasound could not pick up a sub compartment it can still prevent the complication of incomplete surgical release as it correctly identifies the number of tendons. We strongly recommend looking for a sub compartment when the number of tendons seen on ultrasound is more than that found intraoperatively.

DOI: https://doi.org/10.22271/ortho.2017.v3.i4e.47