PMC5627726_01
Ultrasound findings before methotrexate injection.. Notes: (A) Longitudinal scan of the tendons in the first dorsal extensor compartment of the wrist. (B) Transverse scan of the tendons in the first dorsal extensor compartment of the wrist. *The retinaculum. (C) Power Doppler examination of the tendons of the first dorsal extensor compartment of the wrist revealed no activity.
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There were no fibrous septa dividing the first extensor compartment (Figure 1A-C).
Ultrasound findings after methotrexate injection.. Notes: (A) Ultrasound-guided injection by using an in-plane short axis approach. Arrowheads indicate the needle. (B) Transverse scan of the tendons in the first dorsal extensor compartment of the wrist. *The retinaculum. (C) Longitudinal scan of tendons in the first dorsal extensor compartment of the wrist.
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After obtaining written consent, we injected 0.5 mL methotrexate (6.25 mg) with 0.5 mL mepivacaine (15 mg), four times starting from February 15, 2016, with an interval of 10 days between each injection under ultrasound guidance by using the in-plane approach, to target the short axis of the tendon sheath (Figure 2A). A follow-up ultrasound scan revealed a marked reduction in the size of the thickened retinaculum (from 3 to 1.2 mm) and swollen tendons (from 5.5 to 5.1 mm) in comparison with images taken before methotrexate injections (Figure 2B and C).