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De Quervain Injection
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| De Quervain Injection | |
|---|---|
| Indication | De Quervain Tendinopathy |
| Syringe | 1mL |
| Needle | 25G 16mm |
| Steroid | 10-20mg triamcinolone |
| Local | 0.75mL 2% lidocaine |
| Volume | 1mL |
Background
Injection for De Quervain Tendinopathy.
Anatomy
- The APL and EPB usually run together in the first dorsal compartment.
- The tendons can often be seen with the thumb held in resisted extension.
- They can also be palpated at the base of the 1st metacarpal.
- Anatomic variation: septum with two sub compartments (24-76% in cadaver studies). Failure can occur if failure to inject into compartment or only one sub compartment.
Indications
Contraindications
Technique
- Ultrasound guided is preferred with greater clinical improvement, and allows the identification of subcompartment anatomical variation [1][2][3]
- Position: Ulnar side of hand resting on surface with thumbheld in slight flexion
Non-Ultrasound Guided
- Identify: Radial styloid, the APB and EPL tendons, and the gap between them.
- Injection site
- Usual site: is between 5-10mm proximal to the tip of the radial styloid, between the two tendons, through the retinaculum, within the sheath.
- Alternative site in very thin patients: inject distal to the retinaculum, 5mm distal to the radial styloid (due to limited subcutaneous tissue), then advance the needle proximally while injecting
- Insert needle perpendicularly into the gap then slide proximally between the tendons (needle going distal to proximal)
- Inject solution as a bolus
Ultrasound Guided
- Identify: APL and APB tendons in sagittal, retinaculum, radial styloid in transverse
- Stand off gel recommended
- Can be done long axis or short axis. Transverse view is best with the needle entering the sheath while in plan with the transducer.
- Avoid the superficial branch of the radial nerve
- Inject within the tendon sheath.
Complications
- Subcutaneous fat atrophy, particularly noticeable in dark skinned thin women. This may be permanent but generally resolves within 3 months. The risk can be reduced by using hydrocortisone.
- Trauma to superficial radial nerve
Aftercare
Rest hand for one week with taping. Avoid provoking activities and start a graded load programme.
Videos
- ↑ McDermott JD, Ilyas AM, Nazarian LN, et al. Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res. 2012;470:1925–31.
- ↑ Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain’s disease. Skelet Radiol. 2009;38:1099–103.
- ↑ Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain’s tendinitis. J Hand Surg Am. 1998;23:89
