PDF(Pubmed)
Abstract：
Background de Quervain\'s tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians. Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions. Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior-posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively. Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%. Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery. Level of Evidence Level IV, diagnostic study.
摘要：
背景：Quervain的腱鞘炎（DeQ）是一种临床诊断；然而，由于症状与其他病理重叠，做出准确的诊断有时会很有挑战性，特别是对于非骨科培训的医生。问题/目的我们假设radial侧与尺侧软组织肿胀的比率可以用作通用的诊断工具，以帮助将DeQ与其他上肢状况区分开。患者和方法我们回顾性地确定了患有孤立性DeQ（M65.4）的患者，拇指腕掌关节炎（M18。X),或腕管综合征（G56.0x）在2018年至2019年之间。五个失明，独立评审员评估了受影响腕部的前后位X光片.使用数字卡尺测量从桡骨远端外侧皮质和尺骨远端内侧皮质到桡骨和尺骨软组织阴影外缘的最短距离，分别。结果DeQ组的平均桡骨：尺骨比明显大于对照组。类间相关系数在所有测量之间显示出很强的一致性。桡骨：尺骨比率为1.7或更高的患者有61％的机会患有DeQ，敏感性为56.5％。特异性66.3%，59.3%阳性预测值（PPV），阴性预测值为63.8%。超过2.5的比率与具有灵敏度为12.9％的DeQ的55％的机会相关，特异性96.9%，PPV为78.6%。结论桡侧与尺侧腕关节水肿的比值可作为DeQ诊断的新辅助手段。特别是对于那些没有受过骨科或手外科训练的人。证据级别IV级,诊断研究。
