Corticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis

doi:10.1016/j.jhsa.2013.10.013

The Journal of Hand Surgery

Volume 39, Issue 1, January 2014, Pages 37-41

https://doi.org/10.1016/j.jhsa.2013.10.013 Get rights and content

Purpose

To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis.

Methods

In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores.

Results

The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate.

Conclusions

The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes.

Type of study/level of evidence

Therapeutic II.

Section snippets

Methods

Following the approval of the vice chancellor of research and ethic committee of the Guilan University of Medical Sciences and Health Services and registration of the study on the Registry of Clinical Trials, we conducted this study on patients with de Quervain tenosynovitis. The criteria for inclusion in the study were pain on the radial side of the wrist, tenderness at the first dorsal compartment, a positive Finkelstein test, and a pain score greater than 6. The patients who were younger

Results

Both groups were similar with regards to demographic characteristics, dominant hand, affected hand, and occupation status (Table 1). Two patients from the CSI + TSC group (1 died due to unrelated causes and 1 moved to another city) and 1 patient from the CSI group (had a motor vehicle accident) were lost to follow-up before the 3-week post-treatment visit. One patient in the CSI + TSC group and 4 in the CSI group were excluded from the rest of the study because they took analgesics. The

Discussion

The results of this study indicated that the CSI + TSC treatment method was superior to CSI alone with regards to success rate and functional outcomes. The CSI + TSC method was successful in 93% of the patients whereas CSI was successful in 69%. Weiss and colleagues²⁰ in a prospective study of 93 de Quervain patients, examined the efficacy of the use of CSI, a prefabricated thumb spica orthosis, and simultaneous CSI + thumb spica orthosis methods. They found that the treatment success rate was

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Citation Excerpt :
Not all cases are symptomatic enough to warrant treatment but simple interventions, including local ice massage and nonsteroidal anti-inflammatory drugs can be helpful. More symptomatic cases can be resolved in up to 90% of cases with a corticosteroid injection,78 although rest and immobilization can successful alleviate symptoms (at least temporarily) in about 30% of cases.79 Symptoms may recur with resumption of activities, but the temptation to inject multiple times should be tempered by the risks of depigmentation and subcutaneous fat atrophy leading to the much more debilitating superficial radial nerve neuritis.
Proximal Linear Extension of Skin Hypopigmentation After Ultrasound-Guided Corticosteroid Injection for de Quervain Tenosynovitis: A Case Presentation
2018, PM and R
de Quervain tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist that can lead to painful functional impairment of the upper limb. This case presentation describes a rare adverse effect of corticosteroid injection (CSI) involving local skin atrophy and hypopigmentation with proximal linear extension. In this case, hypopigmentation developed from the wrist to beyond the elbow after CSI with ultrasound guidance and targeted placement of the injectate in the extensor tendon sheath of the first dorsal compartment. Dermal complications of CSI are rare but notable and potentially disfiguring events that should be discussed with every patient during the informed consent process before soft tissue CSIs.
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Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review
2018, Archives of Physical Medicine and Rehabilitation
To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.
Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.
In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.
A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders
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Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis
2023, JAMA Network Open
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2023, Hand

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Scientific articleCorticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Methods

Results

Discussion

J Hand Surg Br

Prim Care

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

On a form of chronic tendovaginitis. (Translated article: Cor-Bl.f.schweiz. Aerzrte 1895:25:389-94)

J Hand Surg Br

Histopathology of common tendinopathies. Update and implications for clinical management

Sports Med

Conservative care of De Quervain's tenosynovitis/ tendinopathy in a warehouse worker and recreational cyclist: a case report

J Can Chiropr Assoc

Corticosteroid injection for de Quervain's tenosynovitis

Cochrane Database Syst Rev

Risk factors for de Quervain's disease in a French working population

Scand J Work Environ Health

Scientific article
Corticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis