Quantitative Analysis of Ultrasonography for de Quervain's Disease: Comparison of the Affected Side With the Asymptomatic Side.

ABSTRACT

OBJECTIVES: The pathology of de Quervain's disease affects the tenosynovium and rarely the tendons. The ultrasonographic features of de Quervain's disease unresponsive to conservative treatment are unknown. The purpose of this study was to describe and compare the morphological differences between patients with de Quervain's disease that is refractory to conservative treatment and patients who respond to conservative treatment. METHODS: de Quervain's disease unresponsive to conservative treatment was evaluated in 51 patients. The bilateral wrists underwent preoperative ultrasonographic assessments. The asymptomatic side was presumed to be the patient's anatomical baseline and was used for comparison. We measured the diameter and cross-sectional area of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), and the thickness of the tendon sheath and the intercompartmental septum, if present. The affected side and asymptomatic side were compared. RESULTS: The APL and EPB cross-sectional area was significantly larger on the affected side than on the asymptomatic side (APL 13 mm2 versus 8.3 mm2 ; P < .0001; EPB 5.4 mm2 versus 3.9 mm2 ; P = .031). The tendon sheath was significantly thicker on the affected side (1.5 mm) than on the asymptomatic side (0.95 mm) (P < .0001). The intercompartmental septum was significantly thicker on the affected side (1.1 mm) than on the asymptomatic side (0.72 mm) (P = .0004). Operative findings revealed 41 (80%) patients had an intercompartmental septum. CONCLUSIONS: The ultrasonographic features of de Quervain's disease requiring surgical treatment were a significantly thickened tendon sheath, an intercompartmental septum, and increased cross-sectional area of the APL and EPB.