Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon?

Abstract

Abdallah El-Sayed Allam,1 Doaa Shawky Al-Ashkar,1 Ahmed A Negm,2 Basma Aly Eltawab,3 Wei-Ting Wu,4 Ke-Vin Chang4 1Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 3Department of Radiology, Tanta University Hospitals, Tanta, Egypt; 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan Abstract: De Quervain disease (DQVD) is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times). After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist. Keywords: hand, pain, sonography, rehabilitation

Keywords

• hand
• pain
• sonography
• rehabilitation