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J Wrist Surg 2024; 13(04): 333-338
DOI: 10.1055/s-0043-1772713
Scientific Article

Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis

Stephanie A. Kwan 
1   Department of Orthopaedic Surgery, Jefferson Health, Stratford, New Jersey
,
Joseph E. Massaglia 
1   Department of Orthopaedic Surgery, Jefferson Health, Stratford, New Jersey
,
Daren J. Aita
2   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Jonas L. Matzon 
2   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Michael Rivlin 
3   Department of Hand and Orthopaedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract

Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians.

Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions.

Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior–posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively.

Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%.

Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery.

Level of Evidence Level IV, diagnostic study.

Keywords

de Quervain's - edema - radiographs - tenosynovitis

Note

This work was performed at the Rothman Orthopaedic Institute.


Ethical Approval

This study was reviewed and approved by the Institutional Review Board at Thomas Jefferson University.




Publication History

Received: 04 April 2023

Accepted: 25 July 2023

Article published online:
13 October 2023

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