Subscribe to RSS
DOI: 10.1055/s-0037-1606124
Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients
Publication History
05 May 2017
14 July 2017
Publication Date:
14 August 2017 (online)
![](https://www.thieme-connect.de/media/jws/201802/lookinside/thumbnails/10-1055-s-0037-1606124_1700031-1.jpg)
Abstract
Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT).
Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice.
Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs.
Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically.
Conclusion Wrist radiography does not influence management of patients presenting DQT.
Level of Evidence This is a level III, diagnostic study.
Note
This study was performed at the Department of Orthopaedic Surgery, University of Pennsylvania, Penn Medicine University City, Philadelphia, PA. This nonexperimental study was approved by the University of Pennsylvania Institutional Review Board (protocol #823534).
-
References
- 1 Katzman BM, Steinberg DR, Bozentka DJ, Cain E, Caligiuri DA, Geller J. Utility of obtaining radiographs in patients with trigger finger. Am J Orthop 1999; 28 (12) 703-705
- 2 Wong AS, Jebson PJ, Murray PM, Trigg SD. The use of routine wrist radiography is not useful in the evaluation of patients with a ganglion cyst of the wrist. Hand (NY) 2007; 2 (03) 117-119
- 3 Bindra RR, Evanoff BA, Chough LY, Cole RJ, Chow JC, Gelberman RH. The use of routine wrist radiography in the evaluation of patients with carpal tunnel syndrome. J Hand Surg Am 1997; 22 (01) 115-119
- 4 Pomerance J. Radiographic analysis of lateral epicondylitis. J Shoulder Elbow Surg 2002; 11 (02) 156-157
- 5 Suresh SS, Zaki H, Ali A. Does radial styloid abnormality in de Quervain's disease affect the outcome of management?. Hand (NY) 2010; 5 (04) 374-377
- 6 Chien AJ, Jacobson JA, Martel W, Kabeto MU, Marcantonio DR. Focal radial styloid abnormality as a manifestation of de Quervain tenosynovitis. Am J Roentgenol 2001; 177 (06) 1383-1386
- 7 Dawson C, Mudgal CS. Staged description of the Finkelstein test. J Hand Surg Am 2010; 35 (09) 1513-1515
- 8 Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg 2007; 15 (12) 757-764
- 9 Shehab R, Mirabelli MH. Evaluation and diagnosis of wrist pain: a case-based approach. Am Fam Physician 2013; 87 (08) 568-573