De Quervain's tenosynovitis: the role of ultrasound in management

Background This narrative review discusses de Quervain’s tenosynovitis, a stenosing inflammatory condition affecting the first extensor compartment of the wrist that results in radial styloid pain during thumb and wrist activities. The diagnosis is primarily clinical. Conservative management includes rest, nonsteroidal anti-inflammatory drugs and corticosteroid tendon sheath injections. Main body Inaccurate clinically guided injections and anatomical variations may lead to treatment failure. Ultrasound facilitates precise needle placement and detailed characterization of the first extensor compartment, allowing for a tailored infiltrative approach to optimize clinical outcomes. Several studies show the benefits of ultrasound-guided injections, with a good safety profile. Additionally, it may prevent the injection of corticosteroids outside the tendon sheath and inside the tendon. While complete subcompartmentalization traditionally warrants dual injections when both tendons are involved, the primary pathology in de Quervain’s tenosynovitis typically resides within the extensor pollicis brevis tendon. Notably, recent evidence suggests that a targeted single injection into the EPB sheath provides pain relief comparable to separate subcompartmental injections, regardless of abductor pollicis longus involvement. Emerging therapies, such as platelet-rich plasma injections and US-guided percutaneous release, offer durable results with minimal adverse effects, establishing them as viable contemporary treatment options. Short conclusion Use of ultrasound is essential to determine extensor compartment anatomy and guide intervention.