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Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease

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Abstract

Objective

The aim of this study was to describe the technique and usefulness of ultrasound-guided intrasynovial injection of triamcinolone and bupivacaine in treatment of de Quervain′s disease.

Materials and methods

A total of 17 patients with symptomatic De Quervain′s disease were included in this study. The procedure involved confirmation of diagnosis with ultrasound followed by guided injection of a mixture of 20 mg of triamcinolone (40 mg/ml) and 1 ml of 0.5% bupivacaine. Ultrasound guidance with a high resolution 15-Mhz footprint probe was used for injection into the first dorsal extensor compartment tendon sheath (E1). The response to ultrasound-guided injection was ascertained at the post procedure outpatient clinic appointment according to the follow-up clinic notes.

Results

There were 14 female and 3 male patients aged 29 to 74 years. Mean duration of symptoms was 8.9 months. One patient had an atypical septum in the first extensor compartment and the extensor pollicis brevis alone was involved. The mean post-injection follow-up was at 6.75 weeks. One patient was lost to follow-up. Fifteen out of 16 patients had significant symptomatic relief (93.75%). There were no immediate or delayed complications. Recurrence of symptoms was seen in 3 (20%) patients.

Conclusion

Ultrasound-guided injection of triamcinolone and bupivacaine is safe and useful in controlling symptoms of De Quervain′s disease. Correct needle placement with ultrasound guidance avoids intratendinous injection as well as local complications like fat atrophy and depigmentation.

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References

  1. Piligian G, Herbert R, Hearns M, Dropkin J, Landsbergis P, Cherniack M. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med. 2000;37(1):75–93.

    Article  CAS  Google Scholar 

  2. Sawaizumi T, Nanno M, Ito H. De Quervain’s disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31(2):265–8.

    Article  Google Scholar 

  3. Mahakkanukrauh P, Mahakkanukrauh C. Incidence of a septum in the first dorsal compartment and its effects on therapy of de Quervain's disease. Clin Anat. 2000;13(3):195–8.

    Article  CAS  Google Scholar 

  4. Hart DA, Frank CB, Bray RC. Inflammatory processes in repetitive motion and overuse syndromes: potential role of neurogenic mechanisms in tendons and ligaments. In: Gordon SL, Blair SJ, Fine LJ, editors. Repetitive motion disorders of the upper extremity. Rosemont, IL: AAOS; 1995. p. 247–62.

    Google Scholar 

  5. Trentanni C, Galli A, Melucci G, Stasi G. Ultrasonic diagnosis of De Quervain's stenosing tenosynovitis. Radiol Med. 1997;93(3):194–8.

    CAS  PubMed  Google Scholar 

  6. Nishijo K, Kotani H, Miki T, Senzoku F, Ueo T. Unusual course of the extensor pollicis longus tendon associated with tenosynovitis, presenting as de Quervain disease—a case report. Acta Orthop Scand. 2000;71(4):426–8.

    Article  CAS  Google Scholar 

  7. Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and relief of De Quervain’s tendinitis. J Hand Surg [Am]. 1998;23(1):89–96.

    Article  CAS  Google Scholar 

  8. Yuasa K, Kiyoshige Y. Limited surgical treatment of de Quervain's disease: decompression of only the extensor pollicis brevis subcompartment. J Hand Surg [Am]. 1998;23(5):840–3.

    Article  CAS  Google Scholar 

  9. Bakhach J, Sentucq-Rigal J, Mouton P, Boileau R, Panconi B, Guimberteau JC. The Omega “Omega” pulley plasty: a new technique for the surgical management of the De Quervain′s disease. Ann Chir Plast Esthet. 2006;51(1):67–73.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge Dr Ravi Marudanayagam and the department of Medical Illustration, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, for their help with Figs. 6 and 7.

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Authors and Affiliations

  1. Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK

    Kanagaratnam Jeyapalan & Surabhi Choudhary

Authors
  1. Kanagaratnam Jeyapalan
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  2. Surabhi Choudhary
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Correspondence to Surabhi Choudhary.

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Jeyapalan, K., Choudhary, S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease. Skeletal Radiol 38, 1099–1103 (2009). https://doi.org/10.1007/s00256-009-0721-y

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  • DOI: https://doi.org/10.1007/s00256-009-0721-y

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