Radiology Lectures | Radquarters

Ultrasound of de Quervain’s Tenosynovitis

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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

    Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week!

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    The post Ultrasound of de Quervain’s Tenosynovitis appeared first on Radquarters.

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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