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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