In a controlled, prospective, double-blind study, the incidence of acc
urate injection of the abductor pollicis longus (APL) and extensor pol
licis brevis (EPB) tendon compartments was defined and correlated with
clinical relief of de Quervain's tendinitis. X-ray dye was included w
ith steroid and lidocaine injections for 19 patients; dye location was
immediately checked by 1 radiologist blinded to the clinical results.
Dye was confirmed to be within the first dorsal compartment in 16 of
19 cases. There was relief of symptoms in 11 of 19 patients. Four of 5
patients with dye in both the APL and EPB tendon compartments, experi
enced relief of symptoms, while all 3 with dye in neither compartment
experienced no relief. This suggests that accurate injection of steroi
ds is required for relief of de Quervain's tendinitis. The EPB compart
ment was often missed (13/19 cases), possibly because it was separate
or of small size and deep location. This may be a factor in failed inj
ections, just as surgery can fail if a separate EPB compartment is not
released. Copyright (C) 1998 by the American Society for Surgery of t
he Hand.