Neovascularisation in de Quervain's disease of the wrist: novel combined therapy using sclerosing therapy with polidocanol and eccentric training of the forearms and wrists-a pilot report.
De Quervain's disease has been described as an entrapment of the extensor pollicis brevis and abductor pollicis tendons in the first dorsal compartment of the wrist is a common cause of wrist and hand pain. Currently, intrasheath corticosteroid injections have been reported to be successful as well as surgical release of the first dorsal compartment. We report on three female recreational athletes (median age 57 years, pain VAS 7/10) where we found significant neovascularisation of the extensor retinaculum using Power-Doppler sonography, which was not evident among subjects without de Quervain's disease of the wrist. Polidocanol sclerosing therapy (0.25% 1 ml) was performed with consecutive eccentric training (Thera-Band Flex-Bar, 6 x 15 repetitions of the forearm and wrist extensors and flexors daily). Four weeks later two patients had a resolution of their pain levels (DASH 61 vs. 27, p < 0.05) with resolution of the neovascularisation, while one patient underwent surgery despite pain reduction (6 to 2) 3 weeks following sclerosing therapy. Neovascularisation has been found in de Quervain's disease of the wrist using Power Doppler sonography. Combined treatment with Power Doppler controlled sclerosing therapy with consecutive eccentric training led to encouraging pilot results in terms of pain reduction and functional improvement within 1 month of therapy. A prospective randomized controlled trial is warranted to answer the question whether the sclerosing therapy, the eccentric training or the combination of both is beneficial in de Quervain's disease of the wrist.
Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany. kknobi@yahoo.com
Karsten
K
Knobloch
Andreas
A
Gohritz
Marcus
M
Spies
Peter M
PM
Vogt
D053684:De Quervain Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000295:instrumentation; D010865:Pilot Projects; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000627:therapeutic use; D018084:Ultrasonography, Interventional; D014953:Wrist / Q000098:blood supply*
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols