Ultrasound-Guided Tendon Release for De Quervain’s Disease (De Quervain Tenosynovitis)
De Quervain’s disease, or De Quervain tenosynovitis, is a painful narrowing of the tendon sheath on the thumb side of the wrist. It affects the abductor pollicis longus tendon and the extensor pollicis brevis tendon within the first dorsal extensor compartment. The tendons become less able to glide freely, which may cause pain, swelling and restricted movement in the thumb and wrist area.
If conservative treatment has not provided sufficient improvement, one treatment option is minimally invasive release of the tendon compartment under ultrasound guidance. During the procedure, the physician can visualise the tendons, tendon sheath, nerves and other surrounding anatomical structures in real time, allowing precise release of the narrowed compartment.
What is De Quervain’s disease?
De Quervain’s disease is a stenosing tenosynovitis affecting two tendons on the thumb side of the wrist:
abductor pollicis longus (APL);
extensor pollicis brevis (EPB).
These tendons pass through a narrow tendon compartment on the radial side of the wrist. If the tendon sheath thickens or the compartment becomes narrowed, movement of the tendons may become painful and restricted.
What are the symptoms of De Quervain tenosynovitis?
The most characteristic symptom is pain on the thumb side of the wrist, particularly during gripping, lifting or thumb movements. Possible symptoms include:
pain at the base of the thumb and along the outer side of the wrist;
pain that may radiate towards the thumb or forearm;
swelling on the thumb side of the wrist;
painful thumb movements;
discomfort when gripping or lifting objects;
difficulty performing repetitive thumb and wrist movements;
occasionally, a sensation of friction, clicking or catching during movement.
Symptoms may develop gradually or become more pronounced after repetitive strain involving the wrist and thumb.
What causes De Quervain’s disease?
It is not always possible to identify one specific cause. Repetitive strain on the tendons and their sheaths, individual anatomical variations, and hormonal or physiological changes may contribute to the development of De Quervain tenosynovitis.
The condition is more common:
in people who regularly perform repetitive gripping and thumb movements;
in women;
during pregnancy and the postpartum period;
in people whose wrists are regularly subjected to strain at work, during sport or in everyday activities.
Important: repetitive movements may contribute to symptoms, but a particular occupation or the use of a phone or computer should not be regarded as the sole cause of De Quervain’s disease.
How is De Quervain’s disease diagnosed?
The physician usually makes the diagnosis by assessing:
the location of the pain;
the duration and nature of the symptoms;
thumb and wrist movements;
tenderness in the tendon compartment area;
hand function.
If necessary, a musculoskeletal ultrasound examination is performed.
Ultrasound can be used to assess:
tendon structure;
thickening of the tendon sheath;
fluid around the tendons;
the anatomy of the first dorsal compartment;
additional septa or separate tendon subcompartments.
These anatomical variations are important because they may affect the outcome of injections as well as surgical or minimally invasive release. Ultrasound is used to accurately assess the anatomy of the first extensor compartment and to guide the position of the instrument more safely during the procedure.
At the Diagnostikas centrs branch of Veselības centrs 4, a 17LH7 Hockey Stick ultrasound probe, particularly suitable for examining small anatomical structures, is available. Ultrasound allows detailed assessment of superficially located tendons and other structures of the hand.
How is De Quervain tenosynovitis treated?
Treatment depends on the duration and severity of the symptoms, the condition of the tendons and tendon sheath, and any previous treatment. Conservative treatment is usually used initially.
Conservative treatment
Depending on the patient’s condition, the physician may recommend:
reducing strain on the thumb and wrist;
using a wrist and thumb brace or splint;
adapting ergonomics and everyday movements;
anti-inflammatory treatment, if appropriate for the patient;
physiotherapy or occupational therapy;
injection of medication into the tendon sheath area.
Corticosteroid injections are one of the commonly used non-surgical treatment options, and ultrasound guidance can help ensure accurate administration of the medication, including in cases where anatomical septa are present within the first extensor compartment.
At Diagnostikas centrs, tendon sheath injections for De Quervain tenosynovitis can also be performed under ultrasound guidance.
Minimally Invasive Tendon Release for De Quervain’s Disease Under Ultrasound Guidance
If symptoms persist and conservative treatment has not provided sufficient improvement, ultrasound-guided tendon release may be considered.
More precisely, the procedure does not release the tendon itself but rather the narrowed tendon sheath, or first dorsal extensor compartment, allowing the APL and EPB tendons to glide more freely again.
What is ultrasound-guided tendon release?
It is a minimally invasive treatment procedure during which the physician uses ultrasound to visualise the following structures in real time:
the APL and EPB tendons;
the tendon sheath;
the borders of the first extensor compartment;
any additional septum;
superficial nerves;
surrounding blood vessels.
A specialised instrument is then used to release the structure restricting the free gliding of the tendons.
Published clinical studies describe percutaneous ultrasound-guided release of the first extensor compartment as a minimally invasive method for patients in whom conservative treatment has not provided sufficient improvement.
How is the procedure performed?
The procedure is performed under local anaesthesia. The physician:
assesses the tendons, tendon sheath and surrounding structures using ultrasound;
determines the safest access point;
administers local anaesthesia to the treatment area;
introduces a specialised instrument under ultrasound guidance;
releases the narrowed first tendon compartment;
uses ultrasound to assess the treated area after the release.
Ultrasound allows continuous monitoring of the position of the instrument in relation to the tendons, nerves and other anatomical structures throughout the procedure.
The procedure is performed on an outpatient basis.
What are the advantages of an ultrasound-guided procedure?
Compared with a more extensive open surgical approach, a minimally invasive ultrasound-guided procedure may offer several advantages:
a very small access point to the treatment area;
precise visualisation of the tendons and surrounding structures;
the procedure is performed under local anaesthesia;
less soft-tissue trauma;
sutures are usually not required;
a small scar or puncture site;
potentially faster return to everyday activities.
However, the exact recovery time and outcome of the procedure may vary from patient to patient.
Who may be suitable for the procedure?
Ultrasound-guided tendon release for De Quervain’s disease may be considered for patients who:
have a confirmed diagnosis of De Quervain’s disease;
have persistent pain;
have symptoms that restrict thumb or wrist function;
experience difficulties at work or with everyday activities;
have not achieved sufficient improvement with conservative treatment;
require release of the first extensor compartment and whose anatomy allows a minimally invasive approach.
A physician’s consultation and individual assessment are required before the procedure.
Is ultrasound-guided tendon release an operation?
It is a minimally invasive ultrasound-guided release of the first dorsal extensor compartment. Ultrasound guidance allows the procedure to be performed through a very small access point while important anatomical structures are visualised in real time.
Recovery after the procedure
After the procedure, the treated area may have:
mild swelling;
tenderness;
bruising;
discomfort during certain movements.
Return to light everyday activities and work depends on the patient’s condition and the nature of their work. Physical strain on the wrist should be increased gradually in accordance with the physician’s recommendations.
The exact recovery time varies from patient to patient.
Possible risks
As with any invasive procedure, possible risks include bleeding or bruising, pain or tenderness at the treatment site, persistence or recurrence of symptoms, among others.
The anatomy of the first dorsal compartment may vary between patients, including the presence of additional septa. This is why a detailed ultrasound assessment is particularly important.
When should you see a physician?
A specialist consultation is recommended if:
pain on the thumb side persists for several weeks;
the pain becomes more pronounced;
there is swelling around the wrist;
gripping or lifting objects becomes difficult;
pain interferes with work, sport or everyday activities;
previous treatment has not helped.
Timely diagnosis helps determine whether the symptoms are caused by De Quervain tenosynovitis or another condition affecting the wrist or thumb.
Tendon Release for De Quervain’s Disease in Riga
The procedure is available at the Veselības centrs 4 Diagnostikas centrs, Grebenščikova iela 1, Riga.
The procedure is performed by Dr Matīss Mežals – Algologist, Physical and Rehabilitation Medicine Physician, Ultrasound Specialist.
A physician’s consultation is required before the procedure.
