Clinical Sciences/Health Conditions
Maria Inês Ventura Cabral, N/A, MD
Medical Doctor
Centro de Medicina de Reabilitação de Alcoitão
Carcavelos, Lisboa, Portugal
Cristina Baptista, MD
Medical Doctor
Centro de Medicina de Reabilitação de Alcoitão
Lisboa, Lisboa, Portugal
Afonso Couto, MD
Medical Doctor
Unidade Local de Saúde Amadora Sintra
Lisboa, Lisboa, Portugal
Nuno Silva, MD
Medical Doctor
Unidade Local de Saúde Amadora Sintra
Lisboa, Lisboa, Portugal
De Quervain’s stenosing tenosynovitis (DQST) causes radial wrist pain due to stenosis of the first dorsal compartment containing the APL and EPB tendons. Conservative management—splinting, physical therapy, NSAIDs, and corticosteroid injection—often provides incomplete relief. Open release is effective but carries risks, including incomplete decompression from subcompartmentalization, SBRN or LACN injury, fibrosis, and tendon luxation. Ultrasound (US)-guided percutaneous release may reduce these complications by enabling precise visualization of septations and neural structures.
Case Description:
A 56-year-old woman presented with four months of radial wrist pain unresponsive to NSAIDs, a thumb-spica orthosis, and a corticosteroid–anesthetic injection. Clinical and US evaluation confirmed DQST with Hiranuma type III subcompartmentalization. Before clinical use, the technique was refined on a fresh-frozen cadaver to ensure complete release without neural or vascular injury.
Using a GE HealthCare LOGIQ Fortis with a 24 Hz high-frequency hockey-stick transducer, the SBRN, LACN, and retinaculum boundaries were mapped. Following sterile preparation, 7 mL of 1% lidocaine was used for hydrodissection. A subcision needle was advanced cranial-to-caudal, releasing the deep then superficial retinacular layers, followed by sectioning of the septum between APL and EPB. Complete decompression was confirmed by smooth passage of an 18 G blunt needle under real-time US.
Discussions:
US-guided percutaneous release offers real-time visualization of septations and nearby nerves, reducing risks associated with open surgery such as fibrosis, incomplete release, and neural irritation. Cadaveric optimization standardized probe positioning and needle trajectory. Clinically, QuickDASH improved from 77.3% pre-procedure to 0% at one month, and VAS decreased from 6/10 to 0/10, with no complications.
Conclusions:
US-guided percutaneous release of DQST provides a precise, minimally invasive alternative to open surgery, enabling complete decompression while minimizing neural injury and scarring. This case demonstrated rapid functional recovery, supporting further investigation into its comparative effectiveness and long-term outcomes.
