Henry Tyler W, Tulipan Jacob E, Beredjiklian Pedro K, Matzon Jonas L, Lutsky Kevin F
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania.
J Wrist Surg. 2021 Feb;10(1):48-52. doi: 10.1055/s-0040-1716522. Epub 2020 Oct 16.
The routine use of plain radiography represents a significant expenditure and has been proven unnecessary in several orthopedic conditions. The utility of plain radiographs in the diagnosis of De Quervain's tenosynovitis (DeQ) is not clear. This study evaluates whether plain radiographic findings routinely predict the need for surgery or alter treatment courses in the initial diagnosis of DeQ. A total of 200 patients who received wrist X-rays and had a diagnosis of DeQ were retrospectively selected at random. Their images were evaluated for relevant findings, including radial styloid abnormalities, arthritis, and tendon calcification. A chart review was performed to determine whether these X-rays altered the treatment courses. Of the 200 patients, 141 (69.1%) cases had at least one positive radiographic finding. Carpometacarpal joint (CMC) arthritis was the most common finding, seen in 63 (30.9%) cases. Of all patients, 141 (69.1%) were treated with corticosteroid injection only, 54 (26.5%) with corticosteroid injection and ultimately surgery, and 9 (4.4%) with surgery alone. There were no significant differences in the rates of surgery with positive X-ray findings. There were no cases in which radiographic findings resulted in a change in management, per the report of the treating physician. Despite the high proportion of positive findings on X-ray, no radiographic findings altered the course of treatment in patients with isolated DeQ. Obtaining plain radiographs for isolated DeQ represents a significant cost and should be reserved for cases in which the results are preemptively deemed likely to influence the treatment course. This is a level IV study.
普通X线摄影的常规使用费用高昂，并且已被证明在几种骨科疾病中并无必要。普通X线片在诊断桡骨茎突狭窄性腱鞘炎（DeQ）中的作用尚不清楚。 本研究评估普通X线检查结果是否能常规预测DeQ初始诊断时的手术需求或改变治疗方案。 总共随机回顾性选取了200例接受腕部X线检查且诊断为DeQ的患者。评估他们的影像以寻找相关表现，包括桡骨茎突异常、关节炎和肌腱钙化。进行病历审查以确定这些X线检查是否改变了治疗方案。 在这200例患者中，141例（69.1%）至少有一项阳性X线检查结果。腕掌关节（CMC）关节炎是最常见的表现，见于63例（30.9%）。所有患者中，141例（69.1%）仅接受了皮质类固醇注射治疗，54例（26.5%）接受了皮质类固醇注射并最终接受了手术，9例（4.4%）仅接受了手术。X线检查结果为阳性的患者手术率无显著差异。根据主治医生的报告，没有X线检查结果导致治疗方案改变的病例。 尽管X线检查阳性结果比例较高，但对于孤立性DeQ患者，没有X线检查结果改变治疗进程。对于孤立性DeQ进行普通X线摄影成本高昂，应仅用于预先认为结果可能会影响治疗进程的病例。 这是一项IV级研究。
