Ultrasound presentation of De Quervain's disease
In clinical practice, De Quervain's disease (De Quervain's Disease) is considered a classic stenosing tenosynovitis. Ultrasound is the primary imaging tool for this pathology.
Longitudinal grey-scale ultrasound (grey-scale ultrasound) is considered the optimal diagnostic method. When scanning the tendons of the first dorsal compartment of the wrist, the physician identifies two key structural changes:
- Marked thickening of the tendon itself.
- Echogenic thickening of the tendon sheath.
It is the combination of these findings that confirms the presence of a stenosing process. Power Doppler (power Doppler) is additionally used. It allows for the detection of concomitant tendon neovascularization—the pathological formation of new small blood vessels in the area of active inflammation.
Hand injuries and Stener lesion
The wrist joint (wrist) is regularly subjected to high loads. Overuse injuries (overuse injuries) in this area, which include De Quervain's disease, can lead to significant hand function impairment. In addition, a fall on an outstretched hand is a frequent cause of fractures and severe ligamentous injuries.
In the context of hand injuries, it is critically important to be able to recognize ulnar collateral ligament tear of the thumb (UCL tear).
In normal anatomy on coronal T1-weighted MRI (T1 weighted image), the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint has a characteristic low signal. The adductor aponeurosis (adductor aponeurosis) lies superficial to this ligament.
The pathology occurs as a result of an acute valgus strain injury (valgus strain injury). If a UCL tear occurs, accompanied by retraction of the ligament stump, a Stener lesion (Stener lesion) is diagnosed. Coronal fat-suppressed T2-weighted MRI (FS T2) as well as corresponding longitudinal ultrasound are used for precise visualization of this condition and assessment of the degree of retraction.
Comprehensive assessment of upper extremity joints
For a deep understanding of internal injuries of the upper extremity, it is necessary to consider the biomechanics of other major joints, which are also prone to specific injuries.
The glenohumeral joint (Glenohumeral joint) is inherently unstable. The configuration of its bone and soft tissue structures (acting as static and dynamic stabilizers) provides the maximum possible range of motion while simultaneously making the joint vulnerable. MR arthrography (MR arthrography) is the best method for detecting injuries leading to instability. Tears of the rotator cuff (Rotator cuff tears) are frequently diagnosed in this area. They can be partial thickness (partial thickness) or full thickness (full thickness) and are typically described by their shape. If two or more tendons are involved in the tear, it is classified as a massive tear.
The elbow joint also has its risk zones. The capitellum of the humerus (Capitellum) is the third most frequent location for osteochondritis dissecans (osteochondritis dissecans). In addition, the common flexor and extensor origin sites are frequently affected by insertional tendinopathy (insertional tendinopathy).
Imaging and therapy methods
In cases where elbow tendinopathies prove resistant to standard physical therapy, ultrasound-guided injection or needle therapy is used to aid rehabilitation.
High-resolution diagnostic imaging methods are used to assess the stability of the osteochondral fragment in osteochondritis or to search for loose intra-articular bodies (loose bodies).
| Pathology / Zone | Optimal imaging method | Key diagnostic features |
|---|---|---|
| De Quervain's disease | Longitudinal grey-scale ultrasound, Doppler | Tendon and sheath thickening, neovascularization |
| Stener lesion | MRI (FS T2), longitudinal ultrasound | UCL tear with ligament stump retraction |
| Shoulder instability | MR arthrography (MR arthrography | Assessment of static and dynamic stabilizers |
| Elbow pathologies | MRI, MR arthrography, CT arthrography | Search for loose bodies, assessment of the osteochondral fragment |
To remember a Stener lesion: Stener — Stretched ligament (retraction occurs, meaning the stump of the torn ulnar collateral ligament pulls away).
Class and exam questions
What ultrasound method is used to diagnose De Quervain's disease?
Longitudinal grey-scale ultrasound is used to assess tendon and sheath thickness, and power Doppler mode is used to detect neovascularization.
What is a Stener lesion?
This is a tear of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint, involving retraction (pulling away) of the ligament stump. It occurs from a valgus strain injury.
When is a rotator cuff tear considered massive?
A tear is classified as massive if two or more tendons are involved in the pathological process.
What methods are used for resistant elbow tendinopathies?
In cases where standard physical therapy fails to yield results, ultrasound-guided injection or needle therapy is used to aid rehabilitation.
What else to study on this topic
- Anatomy of the first dorsal compartment of the wrist and their tendon sheaths.
- Biomechanics of a valgus strain injury of the thumb.
- Classification of rotator cuff tears by shape and depth (partial and full-thickness).
- Osteochondritis dissecans of the capitellum of the humerus: mechanisms of loose intra-articular body formation.
- Insertional tendinopathies of the flexors and extensors of the elbow joint: protocols for ultrasound-guided therapy.
Master the entire topic in the "Traumatology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "De Quervain's disease" and 812 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 35 video lessons on the subject
Other topics in the "Additional Topics" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.