[Ultrasonic diagnosis of De Quervain's stenosing tenosynovitis]

This study was aimed at stressing the role of US of the first dorsal compartment of the wrist as the initial diagnostic approach in the study of De Quervain's syndrome, thanks to the high diagnostic yield of this technique. We report on 14 cases of De Quervain's stenosing tenosynovitis whose onset of the symptoms ranged 3-24 months before the US exam. The patients were subdivided into three groups, according to disease stage and US patterns; 5 patients were in group 1, six in group 2 and 3 in group 3. The most frequent US findings were: thickening of the tendons, which appeared as separate structures or as a single structure (pseudofusion); diffuse or, in most cases, focal thickening of the sheaths; changes in tendon echogenicity; impaired tendon sliding, which was reduced or absent due to fibrous adhesions and compression by the sheaths. Diffuse tendon and sheath thickening was prevalent in group 1, where the onset of symptoms ranged 3-10 months earlier. Focal sheath thickening and tendon pseudofusion were prevalent in group 2, where the onset of symptoms ranged 8-15 months earlier. Tendon degeneration and fibrous adhesions between tendons and sheaths, as well as the US changes observed in group 2, were found in group 3 where the onset of symptoms ranged 18-24 months earlier. These US changes were not influenced by medical therapy, with the exception of local injections of corticosteroids. To conclude, we propose a classification of De Quervain's syndrome into three stages, according to the US signs characterizing the different stages of disease evolution and the time of onset of the symptoms.