Sep 12 2024 8 mins 12
In this radiology lecture, we review the ultrasound appearance of de Quervain’s Tenosynovitis!
Key teaching points include:
- Stenosing tenosynovitis of first extensor compartment tendons = Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
- Second most common hand entrapment tendinopathy after trigger finger
- Most common in middle-aged females
- Associations include repetitive hand motions, pregnancy, arthritis, and trauma
- Clinical presentation: Pain with thumb and wrist movement, tenderness and swelling at radial styloid
- Positive Finkelstein maneuver may be present: Grasp thumb, ulnar deviate hand = Pain over distal radius
- Ultrasound findings: Increased fluid in EPB/APL tendon sheath (tenosynovitis), hypoechoic, edematous tendon thickening (tendinosis), and thickening of extensor retinaculum (comparison scanning of contralateral thumb helpful)
- Advanced findings: Impaired tendon movement, tendon tear (anechoic clefts), retinacular and peritendinous hyperemia
- Don’t confuse normal APL slips with longitudinal tear (“lotus root” sign)
- Important to identify variant intertendinous septa: Helps to properly guide steroid injection, increased incidence of asymmetric EPB involvement
- If conservative therapy fails, surgical decompression may be required. More likely when septum present
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4
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