Luca Maria Sconfienza MD, PhD, Presenter: Nothing to Disclose

Davide Orlandi MD, Abstract Co-Author: Nothing to Disclose

Emanuele Fabbro MD, Abstract Co-Author: Nothing to Disclose

Giovanni Mauri MD, Abstract Co-Author: Nothing to Disclose

Giovanni Serafini MD, Abstract Co-Author: Nothing to Disclose

Francesco Sardanelli MD, Abstract Co-Author: Speakers Bureau, Bracco Group Research Grant, Bracco Group Speakers Bureau, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific

De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, caused by a thickening of the retinaculum. Ultrasound-guided intracompartmental steroid injections reported pain relief in up to 97% of patients at 6 months follow-up with a rate of symptoms recurrence up to 20%. We compared the efficacy and the outcome at 6 months follow-up of three different ultrasound-guided treatment options for De Quervain’s disease.

Excluding women with pregnancy-related disease, a consecutive series of 26 patients who presented at our institution to be treated for De Quervain’s disease under ultrasound guidance entered our study. Baseline and follow-up (1,3,6 months) evaluation included US measurement of first dorsal compartment retinaculum maximum thickness, pain assessment (VAS) and disability assessment (quickDASH). All procedures were performed under US guidance with axial scan over the first extensor compartment, and using a medial-to-lateral approach. Patients were randomized into three groups: 1 ml metilprednisolone acetate (group 1; 8 patients, mean age 39±10 years, mean baseline thickness=1.6mm, mean baseline VAS=6.4, mean baseline quickDASH=53), 1 ml triamcinolone acetonide+15-day-delayed 2ml saline 0.9% (group 2;8,44±9,1.3,6.0,56), and 1 ml triamcinolone acetonide+15-day-delayed 2ml low-weight sodium hyaluronate (group 3; 10,43±12,1.7,6.4,55).

No adverse reactions occurred. At 1-month follow-up we found: group 1, mean thickness=0.5mm, mean VAS=1.5, mean quickDASH=22; group 2,0.6,1.4,23; group 3,0.5,1.2,21. At 3-month follow-up: 0.5,1.1,21;0.6,1.2,21;0.4,1.1,21. At 6-month follow-up: 0.8,3.4,32;0.6,2.1,26;0.5,1.0,19. VAS and quickDASH are graphically represented in Figure 1.

Ultrasound-guided intracompartment injection of triamcinolone acetonide+sodium hyaluronate seems to represent a promising approach to treat De Quervain’s disease, reducing symptoms recurrence up to six months.

Combined injection of steroid and hyaluronic acid is effective to treat De Quervain’s disease and prevents symptoms recurrence up to six months.

Sconfienza, L, Orlandi, D, Fabbro, E, Mauri, G, Serafini, G, Sardanelli, F, Ultrasound-guided Percutaneous Injection for De Quervain’s Disease Using Three Different Techniques: Preliminary Results of a Randomized Controlled Trial.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018889.html