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Radiographic Evaluation Does Not Influence Management of Patients with De Quervain Tendinopathy
Nikolas H Kazmers, MD MSE; Tiffany C Liu, BA; Chia Wu, MD MBA; David J. Bozentka, MD; David R. Steinberg, MD; Benjamin L Gray, MD
University of Pennsylvania, Philadelphia, PA
Introduction: Diagnosing de Quervain tendinopathy in a cost-effective fashion holds promise for substantial savings to the healthcare system. We hypothesize that wrist radiography rarely influences a change in the management for patients presenting with de Quervain tendinopathy, and that the frequency of treatment with injection and surgery is similar between patients with and without radiographs who are evaluated within the same practice.
Materials & Methods: Patients diagnosed with de Quervain tendinopathy based upon a classic history and physical examination were identified retrospectively. Demographics, presence versus absence of wrist radiographs, and radiology report findings were tabulated. Clinical records were studied to determine whether radiographic findings correlated with the history or physical examination, and whether they influenced management. Frequencies of treatment with injection and surgical release were tabulated. Cohort demographics and treatments were compared using the Chi-squared test (or Fisher exact test for low-frequency events) and significance level of α=0.05.
Results: A total of 181 patients (189 wrists, mean age 49.6 years) were included: 58% (110 wrists) had wrist radiographic imaging and 42% (79 wrists) did not. There were no differences in demographic factors between cohorts (Table 1). Of those with radiographs, 59 wrists (54%) demonstrated no abnormality, whereas the remainder demonstrated one or more abnormalities (Table 2). Incidental radiographic findings lacking clinical correlation were present in 31 wrists (28%), and potentially clinically pertinent findings (with corroborating clinical findings) in 13 (12%). However, radiographs did not influence a change in management for any of the 110 imaged wrists. There were no differences in the frequency of treatment with corticosteroid injections or surgical release of the first dorsal compartment upon initial presentation, or at most recent follow up, between cohorts with and without radiographs (Table 3). No differences between cohorts in frequency, types, or total number of additional simultaneous surgical procedures were observed for those undergoing surgical release.
Conclusion: Radiographic evaluation is low yield and does not influence management of patients with classic de Quervain tendinopathy.
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