Ultrasound is an excellent tool to diagnose this condition – watch Dr. Fowler demonstrate how and where to scan, and provide techniques for injecting into the 1st dorsal compartment.
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Hi, I'm John Fowler, I'm an orthopedic cancer at the University of Pittsburgh. And I'm going to talk to you today about decoy veins and the ultrasound evaluation of it. So as you all know, Duckworth veins is a very common condition, especially in young women and new moms. It is stenosis. Tennyson, divide us with the first dorsal compartment.
And there's some interesting things we can see under ultrasound, namely that people can have a separate sub compartment and that can be a risk factor for surgery and for a failing non op treatment. So to evaluate this we would place the patient's wrist like this. You really want to feel the tip of the stylus.
Because the downside is if you start ultrasound and distal to the tip of the STI Lloyd the tendons are going to start splitting. And then you can confuse that for a separate sub compartment when it's actually just normal anatomy. So I'm going to feel the tip of her style loin. And I'm going to place the ultrasound transducer in the short axis.
And what you're going to see on the screen, the radial style. Lloyd. Now these are the first compartment tendons right above here. And so I'm going to scan proximal and distal scanning proximally. Scanning distal when I'm looking for is a separate sub compartment which would be a vertical line through the compartment, and she does not have a separate compartment.
Now, if I keep scanning distal, we'll start to see these tendons split. And like I said, if you're not scanning over the radial style you can confuse that for a separate sub compartment. If we look really closely we actually can see her radial sensory nerve coming right across right there. So if someone has Wartenberg syndrome, you can sometimes see some swelling of that nerve as well.
Now if we're going to treat this we would do an injection. And you've got two options. One is you can come from distal proximal in the short axis. And if you do that you will only see the very tip of the needle which is okay. Alternatively you can come from the dorsal side from back here. And though you'd see long axis, we'd see the needle come across the screen, which is really nice because then you can tell your depth of penetration.
If they do have a separate sub compartment, you want to inject in both different compartments. Yeah. So that concludes my demonstration of ultrasound evaluation of the core veins.
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