Utility Of Ultrasonography And Significance Of Surgical Anatomy On The Management Of De Quervain'S Disease: A Systematic Review And Meta-analysis
Jad Abi-Rafeh, MSc, Mehrad Jaberi, MD, MSc, Roy Kazan, MD, PhD, Aziz Alabdulkarim, MD, Stephanie Thibaudeau, MD, FRCSC.
McGill University, Montreal, QC, Canada.
Purpose: The role of ultrasound in plastic surgery practice has grown significantly over the past decade, with notable applications for conditions of the upper extremity. Its utility for the management of De Quervain's disease (DQV) however remains to be established, and the prevalence of first dorsal compartment (FDC) anatomic variations adequately assessed. Methods: A systematic review was performed to evaluate the role of ultrasound in the diagnosis, anatomic characterization and clinical management of DQV. A meta-analysis was conducted to establish the prevalence of FDC anatomic variations in the DQV and general population, along with the diagnostic accuracy of ultrasound for their detection. Outcomes following ultrasound-guided therapies were documented and compared to alternative treatment options. Results: Extensor retinaculum thickening, tendon sheath swelling, preitendenous edema and tendon enlargement were identified as the most common sonographic features of DQV. The prevalence of an intercompartmental septum in the DQV surgical population was shown to be significantly greater than the general cadaveric population, (67% vs. 35%, respectively); ultrasound demonstrated a 95% sensitivity and 96% specificity for its detection, with comparable diagnostic accuracies between surgeon and radiologist sonographers. While the efficacy of energy-based therapeutic ultrasound remains elusive, ultrasound-guided corticosteroid injections were shown to be more accurate than manual injections (90-100% vs. 40-100%), and to confer significantly better treatment outcomes (73-100% vs. 59-83% success rates, respectively). Conclusions: Ultrasound use is essential to ensure the best evidence-based outcomes in the management of DQV; the varied prevalence of FDC anatomic variations in the DQV population, and high accuracy of ultrasound for their detection, carry significant prognostic implications
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