RESUMEN
DeQuervain's disease is a stenosing tenosynovitis. There is inflammation of the cellular lining membrane of the fibrous tube through which the tendons of abductor pollicis Iongus [APL] and extensor pollicis brevis [EPB] move, at the radial styloid process. There is pain and weakness of hand grip. It may occur in association, with rheumatoid arthritis, other inflammatory synovitis, direct trauma, and pregnancy. The purpose of this study was to investigate the value of ultrasound [US] in diagnosis of DeQuervain's disease, to describe US-guided injection technique and demonstration of changes in tendon sheath following US-guided local steroid injection. A cohort of thirty patients with clinical diagnosis of DeQuen,ain's disease and 10 normal subjects were studied prospectively. US examination was performed using HDI 3000 from ATL-USA and linear array transducer 11MHz. The affected tendon sheath was in filtrated with 15 mg triamcinolone diacetate, 2 ml saline and 2 ml of 2% lidociane. The injection was delivered under direct sonographic guidance. US examination was performed following clinical evaluation and repeated at 1 and 12 weeks later. The marginal appearance of tendon sheathes was measured. We used VAS [visual analog scale] 0-10 and hand's grip strength to measure pain. The normal tendons show normal fibrillar hyperechogenicity with no tears or hematoma. The affected tendons of APL and EPB show diffuse circumferential hypoechogenicity around the tendons, distension in the tendon sheath and a surrounding fluid film at the radial styloid process. The US; recognized 3 patients with a different diagnosis of tenosynovitis of the flexor carpiradialis tendon that results in pain at the base of the thenar muscles eminence. The tendons of APL and EPB became inflamed and thickened. US measurements of tendon sheathes showed a significant increase in thickness [range 1.8-2.6 mean 2.4 +/- 0.2 mm], compared with normal subjects [range 0.7-1.2 mean 0.9 +/- 0.3 mm], [P<0.00 1]. In all of our patients, a significant decrease in the thickness of the affected tendon sheath was observed one week after US-guided local steroid injection, [range 1.1-1.5 mean 1.2 +/- 0.2 mm]. Complete relief of symptoms and signs was further observed at 12 weeks. The VAS 0-10 scale and hand's grip strength were significantly improved [P<0.001]. US examination of tendon sheathes is simple, sensitive, easy, safe and quick to perform and reproducible. The US-guided local corticosteroid injection will avoid inappropriate direct injury into the tendon. It was proved to be safe and effective in treatment of DeQuervain's. Therefore. US procedure should be considered early in diagnosis and management of DeQuervain's disease