A painful radial wrist worked through end to end on the linear side of a handheld probe — Lister’s tubercle as the entry point, across the second extensor compartment into the first, then the same structures again lengthwise — with every moment timestamped, the settings read off the device screen, and the whole recording transcribed.
À propos du Dr Mariz
I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women’s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.
À propos du Dr Avila
I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.
Réponse rapide
De Quervain tenosynovitis shows on ultrasound as thickening of the abductor pollicis longus and extensor pollicis brevis tendons inside the first dorsal extensor compartment, enlargement of the retinaculum over them, and effusion in the sheath they share. All three are found with a high-frequency linear probe held across the radial styloid, and confirmed by rotating ninety degrees into long axis. This recording teaches the other half of that skill. A new mother arrives with the classic story — radial wrist pain after a baby, the thing everyone calls mommy wrist — and her first compartment is entirely normal: followed from Lister’s tubercle across the second compartment into the first, screened through in two planes, at 10 MHz. The scan is negative and the diagnosis moves. I would put anyone new to this exam in front of a normal compartment before a diseased one, because a thickened retinaculum only means something once you know precisely what an unthickened one looks like at this frequency. Start at 0:32 for the frequency argument and 1:43 for the scanning.
Looking for the hardware rather than the exam? The MSK medicine hub covers the models used for tendon and small-parts work, and the Page produit D3Ultra carries the full specification and the current price.
The negative scan
Four findings make it De Quervain. This wrist had none of them.
Each panel is one criterion for a positive first extensor compartment, and what this particular wrist showed against it. Click any of them to jump the video to where it is taught or checked.
1A thickened extensor retinaculumThe fibrous roof over the compartment swells and darkens. It is the first thing the presenter names, and the one that gives stenosing tenosynovitis its name.On this wristChecked at 2:42 in short axis and again at 3:05 in long axis. No abnormal thickening.Jump to 0:512Effusion in the shared sheathFluid gathers in the single synovial sheath that abductor pollicis longus and extensor pollicis brevis run through, outlining both tendons against the radius.On this wristNone anywhere in the sweep, on either pass through the compartment.Jump to 0:513Tendinosis of the two tendonsThe tendons themselves thicken and turn hypoechoic — the definition the recording puts on screen as a caption at 1:15.On this wristCalibre and echotexture unremarkable in both planes at this frequency.Jump to 1:154Hyperaemia on DopplerIncreased colour signal in and around the sheath, named on camera as the usual companion of the other three.On this wristNever needed. Doppler is not switched on, because grey scale had already answered.Jump to 1:05
1:43Lister’s tubercleA big bony ridge on the dorsal radius, and the one landmark you can find without hunting.2:20Second compartmentExtensor carpi radialis longus and brevis, immediately radial to the ridge.2:42First compartmentAbductor pollicis longus and extensor pollicis brevis, over the radial styloid.
No positive case is scanned here. The labelled De Quervain image that appears at 0:58 is a published figure the recording displays with its citation printed underneath — Corvino and colleagues, listed under Sources — rather than a live acquisition, and that costs the walkthrough nothing, because what it teaches is the normal a thickened retinaculum has to be measured against. The recording closes on a full-frame slide carrying a treatment protocol for the muscle knot; that is a management instruction rather than an imaging finding, and it has no place on a page about the scan.
Timestamped
Key moments, with the settings
The third column is the part usually missing from a scan video: the preset, depth and transmit frequency showing on the device at that moment. They are worth reading as a set, because nothing in them changes. One preset, one depth, one frequency carry the entire survey, and the only control touched on camera is compound imaging — on for a picture, off for frame rate, with the reason said out loud.
| L'heure | What is on screen | Transducer, preset, depth, frequency |
|---|---|---|
| 0:15 | A new mother’s radial wrist pain, and a doubt about the referraltalk-throughPresenter to camera; the title card covers the software window | |
| 0:32 | Frequency: what 10 MHz still resolves at this depthtalk-throughPresenter to camera | |
| 0:51 | What De Quervain tenosynovitis is, sonographicallytalk-throughA published De Quervain image appears at 0:58 with its own citation printed under it | |
| 1:17 | Positioning, and the split-screen optiontalk-throughThe patient’s hand goes flat on the table; gel on the radial wrist | |
| 1:43 | Lister’s tubercle as the entry landmarkThe software window appears at 1:50; probe placed on the dorsal wrist | Linear · MSK preset · D 20 mm · F H10.0 MHz |
| 1:57 | Compound imaging: frame rate against pictureCompound switched on, then off, while the reason is explained | Linear · D 20 mm · F H10.0 MHz · GN 105 dB · Compound ON then OFF |
| 2:20 | Across the second compartment into the firstLive sweep: the bony ridge, then the two radial wrist extensors | Linear · D 20 mm · F H10.0 MHz · DR 80 · Compound OFF |
| 2:42 | The first compartment, and it is normalFrozen short-axis frame of the first extensor compartment | Linear · D 20 mm · F H10.0 MHz · GN 105 dB · cine 100/100 on freeze |
| 2:57 | Screen through, then look again in long axisTransducer rotated; the same structures run lengthwise | Linear · D 20 mm · F H10.0 MHz · ENH 0 · Compound OFF |
| 3:26 | Back to the patient, with the probe downPalpation and a sustained-pressure test; the pain moves posteriorly | Linear · D 20 mm · F H10.0 MHz — unchanged, probe off the skin |
| 4:07 | The verdict: a muscle knot, not a stenosing tenosynovitisPresenter to camera over a full-frame treatment slide |
Settings transcribed from the device interface visible in the recording. Depth is the D value on screen; frequency is the F value, harmonic. The first four rows are flagged because the software window is still covered by the title card, so no device panel is on screen for them; it appears at 1:50 and stays up to the end.
Reading the images
What this scan shows
The first dorsal extensor compartment is a short fibro-osseous tunnel on the radial side of the wrist. Two tendons run through it, abductor pollicis longus and extensor pollicis brevis, and the extensor retinaculum forms its roof. Lay a linear probe transversely across the radial styloid and both appear as oval, echogenic structures immediately deep to that retinaculum; slide a few millimetres toward the ulna and the two radial wrist extensors of the second compartment sit over the bony indentations beside them.
Three things change when the compartment is diseased. The tendons thicken, the retinaculum over them enlarges, and effusion appears in the sheath; chronic cases add a ganglion arising off the sheath or a partial tear inside a tendon. Every part of that is a comparison, which is why the split-screen offer at 1:17 is worth taking and why one frozen image is never an examination.
The navigation is the part to copy. Lister’s tubercle is a large, unmissable ridge on the dorsal radius, and published technique puts the probe exactly there when all six compartments have to be identified with confidence. From that ridge you count outward, second then first, and rotate ninety degrees to run the same structures lengthwise. Do both, every time: variation inside this compartment is the rule rather than the exception, and a septum between the two tendons reads convincingly as normal tissue when it is only ever seen in one plane.
Verbatim
Full transcript
Transcript — 4:34, 11 passages
Transcribed from the recording and edited for readability; square brackets mark an editorial clarification, and every timestamp moves the video. [Title card and product card omitted, 0:00–0:15.]
The case, and the doubt
0:15…because we have a new mother here who has wrist pain sort of in this region, which is sometimes called mommy wrist because it’s associated with having a new baby. But I have my suspicions that it might not be De Quervain’s disease, because when I do Finkelstein’s test it doesn’t exacerbate her pain.
Frequency, and what 10 MHz can still do
0:32Now, these structures are very shallow, so the higher frequency unit you have, the higher resolution images you will get. So I do recommend something like 15 megahertz, 18 megahertz would give you better pictures — but I’ll show you that even with 10 megahertz we should be able to diagnose this issue.
What De Quervain’s actually is
0:51Now, De Quervain’s disease or tenosynovitis is a stenosing tenosynovitis of the first extensor compartment, containing the abductor pollicis longus and the extensor pollicis brevis. What we expect to see is a markedly thickened retinaculum over that compartment, and it is often associated with hyperaemia — which is increased signal on Doppler — and tendinosis of the tendons.
Positioning, and the split-screen option
1:17In terms of patient positioning, I like to have a table like this where the patient can just plop down their hand and I can move it around and place the transducer on. It’s nice and easy and relaxed for us. So let’s get started. We’ll need some gel; the patient can place their wrist on. Now, if you’re not sure if it looks normal or not, remember you can always use split screen to compare the symptomatic side with the asymptomatic side. So you always have that option.
Starting at Lister’s tubercle
1:43So we’re just going to start with images here. I’m actually going to start with Lister’s tubercle, because that’s a nice, easy-to-find landmark — because it’s a nice big bony landmark.
Compound imaging: frame rate versus picture
1:57Now I can put compound imaging on or off. Off will give me better frame rate; on will give me better pictures. And of course I can look around and move around with it off for that better frame rate, and then I can turn it on when I want to take a picture. So let’s turn it off for now, so I get a slightly improved frame rate.
Walking the compartments
2:20And you can see this bony ridge here — that’s Lister’s tubercle. So as I move, I’ll now be in the second compartment, with extensor carpi radialis brevis and longus; and then if I go even further, even further, we’ll end up in the first compartment.
The first compartment is normal
2:42So there’s the first compartment. And so here we have the first compartment here, and that does not look abnormal to me. There’s no abnormal thickening of that, so that looks normal to me.
Screen through, in two planes
2:57Now, don’t just take one picture. Make sure to screen through structures and to look at structures in two planes. So — come back, don’t go anywhere. Where was I? So here I am. So I’m going to screen through, and I can rotate the transducer. Look in long axis. And yeah, I still don’t see any stenosing tenosynovitis.
Re-examining the patient
3:26Okay, now can you show me where your pain is again? So it’s actually a little bit more posterior. And do you get relief if I hold pressure here? Does the pain start going down? Try that wrist movement and see if it still hurts — does it still hurt? [Patient:] Just a little bit — but the pain is less. [Presenter:] Yeah. Okay.
The verdict
4:07So the pain ended up being a muscle knot and not a stenosing tenosynovitis. Anyway, I hope you found this useful. Cheers.
Hardware
Device and settings
One geometry, one depth, one frequency, and nothing touched between the first image and the last. The left column is what the specification promises; the right is what the screen actually showed while this exam ran, and the right is the one I would copy. Superficial tendon work wants the linear side at the top of its frequency range, because the compartment sits in the top few millimetres of a 20 mm field and axial resolution decides whether a retinaculum looks thickened. On camera at 0:32, Brandon Ramakko, DC, is candid about that ceiling: 15 or 18 MHz would draw this better. So take the trade honestly. If radial wrist tendons and small parts are most of your week, a three-geometry head is not a good fit for that practice: buy a dedicated high-frequency linear probe and accept that it does one job. If the wrist is one exam among a shoulder, an effusion and a lung, the three-in-one is the cheaper answer and it plainly resolved the structures that decided this case.
Published specification, linear side first
Suresult D3Ultra
One head, three geometries — $2,976
- Linéaire7.5 / 10 MHz · 20–100 mm · 40 mm
- Grey scale256 levels · GN 30–105 dB · DR 40–110
- Aperture192 elements · 64 channels
- Also insideConvex, phased · 3.2 / 5.0 MHz
- ModesB · M · colour, power, PW Doppler
- Body263 g · 156 × 65 × 20 mm
- EnduranceAround two hours continuous
- HostsiOS, Android, Windows · dual-band Wi-Fi
What the screen showed, 1:50 to 4:07
- GeometryLinear side · rectangular field for the whole exam
- PresetMSK, named in the title bar beside the probe id
- ProfondeurD 20 mm · unchanged from the first image to the last
- FréquenceF H10.0 MHz, harmonic · the ceiling of this array
- GainGN 105 dB · the top of the published range
- ProcessingDR 80 · ENH 0
- ComposéON at 2:05, OFF from 2:15, and argued on camera
- OutputMI 0.9 · TIS 0.2
- UsedB mode only — no Doppler, no calipers, no split screen
- LogicielV 3.6.78 · header SX-6CT GRCEKR009 · cine 100/100 on freeze
Same head, other structures
Related scans
5:27Carpal tunnel: measuring the median nerveThe other wrist study on this probe — telling nerve from tendon by anisotropy, then taking a cross-sectional area and reading it against published cut-offs.Read the walkthrough →
6:42Rib fracture: following the cortexBone instead of tendon on the same linear array: tracking a rib cortex to the costochondral junction and reading it for a step.Read the walkthrough →
14:09eFAST: the whole trauma study in one passWhat the other two geometries in the same head are for — pericardium, both upper quadrants and the pelvis, scanned in sequence.Read the walkthrough →Every clip in the collection, filterable by anatomy and by probe, sits in the Scan Library.
Asked on this search
Wrist questions
Can ultrasound diagnose De Quervain tenosynovitis?
Yes, and it is the imaging test that fits the question. On ultrasound the condition shows as thickening of the abductor pollicis longus and extensor pollicis brevis tendons inside the first dorsal extensor compartment, enlargement of the retinaculum over them, and effusion in the sheath they share; chronic cases add a ganglion arising from the sheath or a partial intratendinous tear. A high-frequency linear probe held across the radial styloid shows all of it in seconds, with no radiation and with the patient sitting at a table. The diagnosis itself stays clinical, so I use the scan for what imaging is genuinely good at here: confirming the compartment, clearing it, and mapping the anatomy before anyone puts a needle into it.
Source: Wu WT, Chang KV, Tsai YY, Chi SY, Mezian K, Ricci V, Boudier-Revéret M, Özçakar L. USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Wrist/Hand Ultrasonography. Journal of Medical Ultrasound 2026. Accessed September 10, 2026.
What does a normal first extensor compartment look like on ultrasound?
Two oval, echogenic tendons sitting immediately deep to a thin extensor retinaculum, over the radial styloid, with no fluid around them. Slide a few millimetres toward the ulna and the two radial wrist extensors of the second compartment appear over the bony indentations beside them. That is the entire normal picture, and it is what this recording shows: at 2:42 the presenter reads the first compartment as unremarkable, then rotates into long axis at 3:05 and reads it the same way. Recognising it is the part that has to come first: the abnormal picture is only obvious to a reader who has spent time on the ordinary one.
Source: Wu WT, Chang KV, Tsai YY, Chi SY, Mezian K, Ricci V, Boudier-Revéret M, Özçakar L. USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Wrist/Hand Ultrasonography. Journal of Medical Ultrasound 2026. Accessed September 10, 2026.
Why scan the first extensor compartment in two planes?
Because the compartment is rarely a single tunnel. In a series of 74 wrists operated on for de Quervain disease, ultrasound found a complete septum dividing it in 60.8 per cent, an incomplete septum in 31.1 per cent and no septum in 8.1 per cent, and 70.3 per cent had a multi-slip abductor pollicis longus. A review pooling 35 studies put the septum at 47 per cent in wrists with the disease against 39.3 per cent in cadaveric wrists. A septum read in one plane can pass for normal tissue, and it is the reason an injection into the obvious subcompartment can miss the painful one entirely.
Source: Lee YS, Choi WS, Baek SH, Kang H, Lee CH. Comparative analysis of ultrasound and surgical findings in anatomical variations of de Quervain’s disease. Clinics in Orthopedic Surgery 2025;17(2):308–316. Accessed September 10, 2026.
The wrist still hurts but the scan is normal. What else should be checked?
Work outward from the radial styloid. Intersection syndrome sits about four centimetres proximal to the wrist where the first compartment muscles cross the radial wrist extensors, often with crepitus, and shows as a hypoechoic zone between the two compartments in short axis. Osteoarthritis of the thumb carpometacarpal joint, a scaphoid or radial styloid fracture, irritation of the superficial radial nerve and trigger thumb all present as radial wrist pain. In this case the answer was none of those: the pain sat more posteriorly, eased under sustained pressure, and the presenter calls it a muscle knot at 4:07.
Source: Beutel BG, Taylor K, Michols NJ, Taqi M. Intersection syndrome. StatPearls, NCBI Bookshelf; updated 23 May 2025. Accessed September 10, 2026.
What probe frequency does this scan need?
Ten megahertz answered the question here, and the presenter says plainly at 0:32 that 15 or 18 megahertz would draw it better. Both statements are true and neither cancels the other. The structures sit in the top few millimetres of a 20 millimetre field, which is exactly where axial resolution decides whether a retinaculum looks thickened, so higher frequency is always the better picture. What this recording demonstrates is the floor rather than the ceiling: a compartment can be cleared at the top of a 10 megahertz linear array, provided the operator screens through it in two planes instead of taking one picture.
Source: POCUS for De Quervain’s tenosynovitis — Suresult channel, 13 October 2025. Accessed September 10, 2026.
Provenance
Sources
- Wu WT, Chang KV, Tsai YY, Chi SY, Mezian K, Ricci V, Boudier-Revéret M, Özçakar L. USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Wrist/Hand Ultrasonography. Journal of Medical Ultrasound 2026Scanning protocol for the six extensor compartments — first compartment contains APL and EPB, tendons appear as oval echogenic structures deep to the retinaculum with the transducer transverse over the radial styloid, and the probe is best positioned where the bony contour of Lister’s tubercle is distinctly visualised. De Quervain tenosynovitis is characterised by tendon thickening, enlargement of the overlying retinaculum and sheath effusion. Accessed September 10, 2026.
- Corvino A, Lonardo V, Corvino F, Tafuri D, Pizzi AD, Cocco G. “Daddy wrist”: a high-resolution ultrasound diagnosis of de Quervain tenosynovitis. Journal of Clinical Ultrasound 2023;51(5):845–847The paper displayed on screen at 0:58 with its citation printed beneath the image. Records the female-to-male ratio of about 10 to 1, a peak between 30 and 50 years, and the association with repeatedly lifting a child that produced the terms mommy wrist and daddy wrist. Accessed September 10, 2026.
- Lee YS, Choi WS, Baek SH, Kang H, Lee CH. Comparative analysis of ultrasound and surgical findings in anatomical variations of de Quervain’s disease. Clinics in Orthopedic Surgery 2025;17(2):308–316Seventy-four wrists examined by ultrasound and then at surgery: complete septum 60.8 per cent, incomplete 31.1 per cent, none 8.1 per cent, multi-slip APL 70.3 per cent, EPB stenosis 66.2 per cent. Sensitivity and specificity against the surgical reference were 100 and 99.2 for no septum and 98.3 and 90.4 for a complete septum. Accessed September 10, 2026.
- Kotzias D, Koutserimpas C, Chrysikos D, Bekos F, Georgakopoulos P, Tsakotos G, Salmas M, Piagkou M, Troupis T. Clinical considerations of first extensor wrist compartment variants and de Quervain’s disease: a review study. Cureus 2023;15(7):e42124Thirty-five studies, 2,573 wrists. An inter-tendinous septum was present in 42.9 per cent overall — 47 per cent of wrists in patients with the disease against 39.3 per cent of cadaveric wrists. Accessed September 10, 2026.
- Satteson E, Tannan SC. De Quervain tenosynovitis. StatPearls, NCBI Bookshelf; updated 22 November 2023Diagnosis is clinical. Finkelstein and Eichhoff provocative tests are described; the typical patient is a woman in the third trimester or a breastfeeding mother who repeatedly lifts her child. Differentials for radial wrist pain: thumb carpometacarpal osteoarthritis, scaphoid fracture, radial styloid fracture, superficial radial nerve neuritis, intersection syndrome and trigger thumb. A septum in the compartment is listed among the risk factors for failure of non-operative treatment. Accessed September 10, 2026.
- Beutel BG, Taylor K, Michols NJ, Taqi M. Intersection syndrome. StatPearls, NCBI Bookshelf; updated 23 May 2025Pain and swelling on the dorsal radial forearm about four centimetres proximal to the wrist, sometimes with crepitus; incidence under one in 100,000 a year. On ultrasound a linear probe in the transverse plane shows a hypoechoic area between the two dorsal compartments. Tenderness in de Quervain tenosynovitis sits more distally, at the radial styloid, without crepitus. Accessed September 10, 2026.
- Page produit Suresult D3UltraPublished specification and current price for the unit used in this recording. Accessed September 10, 2026.
- POCUS for De Quervain’s tenosynovitis — Suresult channel, 13 October 2025The recording transcribed on this page, presented by Brandon Ramakko, DC. Accessed September 10, 2026.
Wrist tendons at 10 MHz, or a probe built for them?
This compartment lives in the top few millimetres, where every megahertz shows. A three-geometry head clears it and still covers a shoulder, a lung and an abdomen; a dedicated high-frequency linear probe draws the retinaculum better and does nothing else. Send the case mix and the setting and the answer comes back in one conversation — one probe, two, or neither.
