Similar bias could be found in the studies that suggested an association between the presence of the septum and the poor outcome after local steroid injection in de Quervain's disease. Witt et al.  indicated the intracompartmental septum could be a possible cause of steroid injection failure in patients with de Quervain's disease, based on the observation that 22 of 30 patients (73%) unresponsive to steroid injections had an intracompartmental septum, which was greater than numbers reported in cadaveric studies. Other authors shared this view, reporting a higher prevalence of the intracompartmental septum in patients who experienced steroid treatment failure [5, 18]. However, these studies inadequately support the association between the presence of an intracompartmental septum and steroid treatment failure because responders to nonoperative treatment were not used as control subjects. This type of comparative study has been difficult to conduct for ethical reasons as the information for those who responded to nonoperative treatment could be obtained only by surgical exploration. We believe sonography provides an effective diagnostic tool for this purpose.
An accurate injection of steroid into both compartments reportedly improves the outcomes in patients with de Quervain's disease. Zingas et al.  reported a higher rate of symptom relief was attained in patients with successful steroid injections into the APL and EPB compartments than that with a steroid injection only into the APL or none of the compartments. Exact delivery of steroids into both compartments under the guidance of sonography may lead to improved outcomes.
Sonography is useful to identify the intracompartmental septum in the first extensor compartment in patients with de Quervain's disease. Sonographic examinations may be used to verify whether the intracompartmental septum is a risk factor for steroid injection failure and disease development and to accurately deliver steroids into both compartments in patients with de Quervain's disease.
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