Ultrasound of de Quervain’s Tenosynovitis

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