Abstract
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.
Keywords
De Quervain's tenosynovitis - tenosynovitis - diagnosis - radiograph - X-ray
