Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis?Funding None.
Background The routine use of plain radiography represents a significant expenditure and has been proven unnecessary in several orthopedic conditions. The utility of plain radiographs in the diagnosis of De Quervain's tenosynovitis (DeQ) is not clear.
Questions/Purpose This study evaluates whether plain radiographic findings routinely predict the need for surgery or alter treatment courses in the initial diagnosis of DeQ.
Patients and Methods A total of 200 patients who received wrist X-rays and had a diagnosis of DeQ were retrospectively selected at random. Their images were evaluated for relevant findings, including radial styloid abnormalities, arthritis, and tendon calcification. A chart review was performed to determine whether these X-rays altered the treatment courses.
Results Of the 200 patients, 141 (69.1%) cases had at least one positive radiographic finding. Carpometacarpal joint (CMC) arthritis was the most common finding, seen in 63 (30.9%) cases. Of all patients, 141 (69.1%) were treated with corticosteroid injection only, 54 (26.5%) with corticosteroid injection and ultimately surgery, and 9 (4.4%) with surgery alone. There were no significant differences in the rates of surgery with positive X-ray findings. There were no cases in which radiographic findings resulted in a change in management, per the report of the treating physician.
Conclusions Despite the high proportion of positive findings on X-ray, no radiographic findings altered the course of treatment in patients with isolated DeQ. Obtaining plain radiographs for isolated DeQ represents a significant cost and should be reserved for cases in which the results are preemptively deemed likely to influence the treatment course.
Level of Evidence This is a level IV study.
The investigation was performed at Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
Eingereicht: 08. Juni 2020
Angenommen: 06. August 2020
Artikel online veröffentlicht:
16. Oktober 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Bindra RR, Evanoff BA, Chough LY, Cole RJ, Chow JC, Gelberman RH. The use of routine wrist radiography in the evaluation of patients with carpal tunnel syndrome. J Hand Surg Am 1997; 22 (01) 115-119
- 2 Deyo RA, Diehl AK. Lumbar spine films in primary care: current use and effects of selective ordering criteria. J Gen Intern Med 1986; 1 (01) 20-25
- 3 Liu AC, Byrne E. Cost of care for ambulatory patients with low back pain. J Fam Pract 1995; 40 (05) 449-455
- 4 Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am 2009; 34 (01) 112-115
- 5 Wu F, Rajpura A, Sandher D. Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease. J Hand Microsurg 2018; 10 (02) 116-118
- 6 Chien AJ, Jacobson JA, Martel W, Kabeto MU, Marcantonio DR. Focal radial styloid abnormality as a manifestation of de Quervain tenosynovitis. AJR Am J Roentgenol 2001; 177 (06) 1383-1386
- 7 Suresh SS, Zaki H, Ali A. Does radial styloid abnormality in de Quervain's disease affect the outcome of management?. Hand (N Y) 2010; 5 (04) 374-377
- 8 U.S. Centers for Medicare & Medicaid Services. Physician Fee Schedule Search. Accessed January 15, 2020 at: https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=2&H1=73110&C=96&M=5
- 9 U.S. Centers for Medicare & Medicaid Services. CMS-1715-F. Accessed January 1, 2020 at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F
- 10 Finkelstein H. Stenosing tendovaginitis at the radial styloid process. JBJS J 1930; 12 (03) 509-540
- 11 Weston WJ. De Quervain's disease--stenosing fibrous tendovaginitis at the radial styloid process. Br J Radiol 1967; 40 (474) 446-448
- 12 Stone JD, Vaccaro LM, Brabender RC, Hess AV. Utility and cost analysis of radiographs taken 2 weeks following plate fixation of distal radius fractures. J Hand Surg Am 2015; 40 (06) 1106-1109
- 13 Stiell I. Ottawa ankle rules. Can Fam Physician 1996; 42 (MAR): 478-480
- 14 Giovagnorio F, Andreoli C, De Cicco ML. Ultrasonographic evaluation of de Quervain disease. J Ultrasound Med 1997; 16 (10) 685-689
- 15 McDermott JD, Ilyas AM, Nazarian LN, Leinberry CF. Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res 2012; 470 (07) 1925-1931
- 16 Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain's tenosynovitis. Ann Rheum Dis 2002; 61 (11) 1034-1035
- 17 Klug JD. MR diagnosis of tenosynovitis about the wrist. Magn Reson Imaging Clin N Am 1995; 3 (02) 305-312