Ultrasound allows precise tendonitis treatment

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Ultrasound is proving useful in guiding injections of cortisone to treat “De Quervain’s tendonitis”—a painful repetitive strain injury in which tendons in the wrist and hand become inflamed.

According to Dr. Ronald Adler, “the condition was initially described in new mothers who hyperextend their thumbs when they hold their babies head. But we see it in older individuals also. We see a fair number of patients every month with this condition.”

The primary symptom of De Quervain’s tendonitis, which is sometimes referred to as “new mom’s syndrome,” is pain over the thumb side of the wrist. The pain may come on suddenly or gradually and may get worse with normal use of the hand and thumb. In some cases, the pain may radiate up the arm.

De Quervain’s tendonitis is difficult to control and recover from, said Adler, chief of the division of ultrasound and body CT at the Hospital for Special Surgery in New York. People suffering from the condition often get shots of cortisone around the affected tendons, but getting the cortisone to the right spot can prove tricky.

“Ideally, you want to inject cortisone around the tendons,” Adler explained. “You don’t want to inject it in the tendon because that weakens the tendon and predisposes to further damage. We can palpate where the tendons lie but we can’t visualize them. There are a lot of other touchy areas you need to avoid as well.”

“The benefit with ultrasound,” Adler said, “is that we have direct visualization of the tendons and tendon sheaths and we can see where the best place to position the needle is.”

Ultrasound is performed in “real time” so doctor’s injecting the cortisone know where the needle is relative to the tendons, arteries and nerves. “We monitor the injection as we are doing it so we can see that we are injecting around the tendons as opposed to within the tendons,” Adler said.

In most cases, with this precision treatment, patients experience immediate relief and after a few days their pain often subsides completely, according to Adler.

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