Subscribe to RSS
DOI: 10.1055/s-0043-1772713
Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis
Abstract
Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians.
Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions.
Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior–posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively.
Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%.
Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery.
Level of Evidence Level IV, diagnostic study.
Note
This work was performed at the Rothman Orthopaedic Institute.
Ethical Approval
This study was reviewed and approved by the Institutional Review Board at Thomas Jefferson University.
Publication History
Received: 04 April 2023
Accepted: 25 July 2023
Article published online:
13 October 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Adams JE, Habbu R. Tendinopathies of the hand and wrist. J Am Acad Orthop Surg 2015; 23 (12) 741-750
- 2 Sato J, Ishii Y, Noguchi H. Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease. J Hand Surg Eur Vol 2016; 41 (02) 220-225
- 3 Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 2004; 51 (04) 642-651
- 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 de Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop 1997; 26 (09) 641-644
- 6 McBain B, Rio E, Cook J, Grabinski R, Docking S. Diagnostic accuracy of imaging modalities in the detection of clinically diagnosed de Quervain's syndrome: a systematic review. Skeletal Radiol 2019; 48 (11) 1715-1721
- 7 Dawson C, Mudgal CS. Staged Description of the Finkelstein Test. J Hand Surg 2010; 35 (09) 1513-1515
- 8 Lane LB, Boretz RS, Stuchin SA. Treatment of de Quervain's disease: role of conservative management. J Hand Surg [Br] 2001; 26 (03) 258-260
- 9 Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg 2007; 15 (12) 757-764
- 10 Henry TW, Tulipan JE, Beredjiklian PK, Matzon JL, Lutsky KF. Are plain X-rays necessary in the diagnosis of De Quervain's tenosynovitis?. J Wrist Surg 2021; 10 (01) 48-52
- 11 Warrender WJ, Salmons HI, Pham P, Watkins C, Jones C, Rivlin M. Physiological nocturnal hand swelling: a prospective evaluation of healthy volunteers. J Hand Surg Am 2019; 44 (03) 245.e1-245.e5
- 12 Wolfe SW, Pederson WC, Kozin SH, Cohen MS. Green's Operative Hand Surgery. . 8th ed. Philadelphia, PA: Elsevier, Inc; 2022
- 13 Warrender WJ, Salmons HI, Pham P, Watkins C, Jones C, Rivlin M. Physiological nocturnal hand swelling: a prospective evaluation of healthy volunteers. J Hand Surg Am 2019; 44 (03) 245.e1-245.e5