Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 5 , ISSUE 2 ( July-December, 2023 ) > List of Articles


Correlation between EPB Entrapment Test and Ultrasound Wrist Findings in Patients with De Quervain's Disease

Vijayaraja Elangovan, Srinivasan Rajappa, Gokul K Jeganathan, Lokesh K Sekaran

Keywords : Anatomical variations, Bony crest, De Quervain's disease, Extensor pollicis brevis entrapment test, Intracompartmental septa, Sub-compartmentalization

Citation Information : Elangovan V, Rajappa S, Jeganathan GK, Sekaran LK. Correlation between EPB Entrapment Test and Ultrasound Wrist Findings in Patients with De Quervain's Disease. 2023; 5 (2):45-49.

DOI: 10.5005/jojs-10079-1114

License: CC BY-NC 4.0

Published Online: 07-07-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The reliability of clinical tests in diagnosing De Quervain's disease has been established, but the presence of subcompartmentalization is difficult to identify, which gave the origin of the extensor pollicis brevis (EPB) entrapment test. Diagnosis of several other anatomical variations like a bony crest, multiple abductor pollicis longus (APL), and EPB slips are necessary. However, surgical inspection is the gold standard method for diagnosing anatomical variation, but the improvement in diagnostic efficacy for better prognosis by combining clinical and ultrasound examination is to be assessed. Aim: To determine the correlation between EPB entrapment test and ultrasound wrist findings in patients with de Quervain's tenosynovitis in the detection of anatomical variations of the first extensor compartment. Materials and methods: A total of 40 Finkelstein's test-positive wrists underwent EPB entrapment test and ultrasonography (USG) examination by a surgeon and a radiologist, respectively. Radiological evidence of sub-compartmentalization and other anatomical variations were recorded. Both the surgeon and radiologist were blinded to each other's results. Surgery was done as a reference standard. Results: The sensitivity of the EPB entrapment test in identifying the sub-compartmentalization is 73.6%, and that of the ultrasound examination is 97.4%, with a majority of the distal incomplete septum (75%). The mean number of APL slips was three, and one wrist had multiple EPB slips.3 Ultrasound also showed a bony crest in the radial styloid of 39 wrists (97.5%) Conclusion: The extensor pollicis brevis (EPB) entrapment test, a reliable and simple clinical test for identifying sub-compartmentalization of the first extensor compartment but in combination with ultrasound examination, which identifies anatomical variations, could be vital in deciding appropriate treatment and effective surgical release, thereby preventing treatment failures.

  1. Jackson WT, Viegas SF, Coon TM, et al. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am 1986;68(6):923–926. DOI: 10.2106/00004623-198668060-00016
  2. Finkelstein H. Stenosing tendovaginitis at the radial styloid process. JBJS 1930;12(3):509–540.
  3. EE Zur. Pathogenese der Tendovaginitis stenosans. Bruns Beitrage Z Klin Chir 1927;0:746–755. PMID: 25745911.
  4. Wu F, Rajpura A, Sandher D. Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease. J Hand Microsurg 2018;10(2):116–118. DOI: 10.1055/s-0038-1626690
  5. Alexander RD, Catalano LW, Barron OA, et al. The extensor pollicis brevis entrapment test in the treatment of de Quervain's disease. J Hand Surg Am 2002;27(5):813–816. DOI: 10.1053/jhsu.2002.35309
  6. Giles KW. Anatomical variations affecting the surgery of de Quervain's disease. J Bone Joint Surg Br 1960;42-B:352–355. DOI: 10.1302/0301-620X.42B2.352
  7. Clarke MT, Lyall HA, Grant JW, et al. The histopathology of de Quervain's disease. J Hand Surg 1998;23(6):732–734. DOI: 10.1016/s0266-7681(98)80085-5
  8. Lee ZH, Stranix JT, Anzai L, et al. Surgical anatomy of the first extensor compartment: a systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. J Plast Reconstr Aesthetic Surg JPRAS 2017;70(1):127–131. DOI: 10.1016/j.bjps.2016.08.020
  9. Dos Remédios C, Chapnikoff D, Wavreille G, et al. The abductor pollicis longus: relation between innervation, muscle bellies and number of tendinous slips. Surg Radiol Anat SRA. 2005;27(3):243–248. DOI: 10.1007/s00276-004-0286-3
  10. (PDF) Anatomical variations in the first dorsal compartment of the wrist: meta-analysis [Internet]. [cited 2022 Dec 15]. Available from:
  11. Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg 1998;23(1):89–96. DOI: 10.1016/S0363-5023(98)80095-6
  12. Nayak SR, Hussein M, Krishnamurthy A, et al. Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers. Chang Gung Med J 2009;32(6):600–604.
  13. Lee KH, Kang CN, Lee BG, et al. Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci 2014;19(1):49–54. DOI: 10.1007/s00776-013-0481-3
  14. Rousset P, Vuillemin-Bodaghi V, Laredo JD, et al. Anatomic variations in the first extensor compartment of the wrist: accuracy of US. Radiology 2010;257(2):427–433. DOI: 10.1148/radiol.10092265
  15. Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am 1994;19(4):595–598. DOI: 10.1016/0363-5023(94)90262-3
  16. Harvey FJ, Harvey PM, Horsley MW. De Quervain's disease: surgical or nonsurgical treatment. J Hand Surg 1990;15(1):83–87. DOI: 10.1016/s0363-5023(09)91110-8
  17. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop 2007;31(2):265–268. DOI: 10.1007/s00264-006-0165-0
  18. Kume K, Amano K, Yamada S, et al. In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. J Hand Surg Eur Vol 2012;37(6):523–527. DOI: 10.1177/1753193411427829
  19. Earp BE, Han CH, Floyd WE, et al. De Quervain tendinopathy: survivorship and prognostic indicators of recurrence following a single corticosteroid injection. J Hand Surg 2015;40(6):1161–1165. DOI: 10.1016/j.jhsa.2014.12.027
  20. Lalonde D, Eaton C, Amadio PC, et al. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery. Instr Course Lect 2015;64:249–259.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.