Management Outcome of de Quervain’s Disease with Corticosteroid Injection Versus Surgical Decompression

Document Type : RESEARCH PAPER

Author

Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan

Abstract

Abstract Background: This randomized clinical trial was undertaken to document the clinical presentation of de Quervain’s disease and evaluate the outcome of management with triamcinolone acetonide (TAC) injection versus surgical decompression. Methods: Half of the patients were assigned to the corticosteroid injection group (group A) and half to the surgery group (group B). In group A, 40 mg of TAC was injected into the affected first extensor compartment. In group B, surgical decompression of first extensor compartment was performed. Results: There were 56 patients with 38 (67.85 %) females and 18(32.14%) males. The age range was 23-66 years. In group A, one injection was employed among 7(25%) patients whereas two injections among 21(75%) patients. Local complications with injections were observed among 7 patients. Symptomatic relief with injection at 6-weeks was observed among 25% patients whereas recurrence at one year was observed among 9(32.14%) patients. In group B, no critical complications were encountered following surgery; all the patients had symptomatic relief at 6-weeks and there was no case with recurrence at one year. Conclusion: Surgical decompression provided superior results in terms of providing symptomatic relief at 6-weeks among all patients, absence of complications and no recurrence. The corticosteroid injections (CSI) were associated with the need for repeat injections among 75% cases and a recurrence rate of 32.14% at one year, rendering it to be comparatively a poorer choice. Level of evidence: II

Keywords


1. Wolfe SW. Tendinopathy. In: Wolfe SW, Hotchkiss RN,
Kozin SH, Peterson WC, Cohen MS, editors. Green’s
textbook 7thed. Philadelphia: Elsevier; 2017. p.1916-
1919.
2. Huisstede BM, Coert JH, Fridén J, Hoogvliet P, European
HANDGUIDE Group. Consensus on a multidisciplinary
treatment guideline for de Quervain disease: results
from the European HANDGUIDE study. Physical
therapy. 2014; 94(8):1095-110.
3. Lalonde DH, Kozin S. Tendon disorders of the hand.
Plastic and reconstructive surgery. 2011; 128(1):1e-4e.
4. Scheller A, Schuh R, Hönle W, Schuh A. Long-term
results of surgical release of de Quervain’s stenosing
tenosynovitis. International orthopaedics. 2009;
33(5):1301-3.
5. Peters‐Veluthamaningal C, van der Windt DA, Winters
JC, Meyboom‐de Jong B. Corticosteroid injection for
de Quervain’s tenosynovitis. Cochrane Database of
Systematic Reviews. 2009(3).
6. Ilyas AM. Nonsurgical treatment for de Quervain’s
tenosynovitis. Journal of Hand Surgery. 2009;
34(5):928-9.
7. Waseem M, Khan M, Hussain N, Giannoudis PV, Fischer
J, Smith RM. Eponyms: errors in clinical practice and
scientific writing. Acta Orthop Belg. 2005; 71(1):1-8.
8. Montori VM, Guyatt GH. Intention-to-treat principle.
Cmaj. 2001; 165(10):1339-41.
9. Walker‐Bone K, Palmer KT, Reading I, Coggon D,
Cooper C. Prevalence and impact of musculoskeletal
disorders of the upper limb in the general population.
Arthritis Care & Research. 2004; 51(4):642-51.
10. Yoong JK. Mobile phones can be a pain--text messaging
tenosynovitis. Hospital medicine (London, England:
1998). 2005; 66(6):370.
11. Foye PM, Cianca JC, Prather H. 3. Cumulative trauma
disorders of the upper limb in computer users. 
Archives of physical medicine and rehabilitation.
2002; 83:S12-5.
12. Le Manac’h AP, Roquelaure Y, Ha C, Bodin J, Meyer G,
Bigot F, et al. Risk factors for de Quervain’s disease in
a French working population. Scandinavian journal of
work, environment & health. 2011:394-401.
13. Tendon trouble in the hands: de Quervain’s
tenosynovitis and trigger finger. Women are more
likely than men to develop these painful conditions.
Harv Womens Health Watch. 2010; 17(8):4–5.
14. Wolf JM, Sturdivant RX, Owens BD. Incidence of de
Quervain’s tenosynovitis in a young, active population.
The Journal of hand surgery. 2009; 34(1):112-5.
15. Garçon JJ, Charruau B, Marteau E, Laulan J, Bacle
G. Results of surgical treatment of De Quervain’s
tenosynovitis: 80 cases with a mean follow-up of
9.5 years. Orthopaedics & Traumatology: Surgery &
Research. 2018; 104(6):893-6.
16. Mehdinasab SA, Alemohammad SA. Methylprednisolone
Acetate Injection plus Casting Versus Casting Alone
for the Treatment of de Quervain’s Tenosynovitis.
Arch Iranian Med. 2010; 13(4): 270-74.
17. Sawaizumi T, Nanno M, Ito H. De Quervain’s disease:
efficacy of intra-sheath triamcinolone injection.
International orthopaedics. 2007; 31(2):265.
18. Ashurst JV, Turco DA, Lieb BE. Tenosynovitis caused
by texting: an emerging disease. The Journal of the
American Osteopathic Association. 2010; 110(5):
294-6.
19. Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness
of corticosteroid injections for treatment of de
Quervain’s tenosynovitis. Hand. 2017; 12(4): 357–361.
20. Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn
K, Jianmongkol S, Chatuparisute P, Jung S. Treatment of
de Quervain disease with triamcinolone injection with
or without nimesulide: A randomized, double-blind, 
placebo-controlled trial. JBJS. 2004; 86(12):2700-6.
21. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical
treatment measures for de Quervain’s disease of
pregnancy and lactation. The Journal of hand surgery.
2002; 27(2):322-4.
22. Zingas C, Failla JM, Van Holsbeeck M. Injection
accuracy and clinical relief of de Quervain’s tendinitis.
The Journal of hand surgery. 1998; 23(1):89-96.
23. Chang CY, Kheterpal AB, Vicentini JR, Huang AJ.
Variations of anatomy on MRI of the first extensor
compartment of the wrist and association with
DeQuervain tenosynovitis. Skeletal Radiology. 2017;
46(8):1047-56.
24. Sato J, Ishii Y, Noguchi H. Ultrasonographic evaluation
of the prevalence of an intracompartmental septum
in patients with de Quervain’s disease. Orthopedics.
2016; 39(2):112-6.
25. Liang J, McElroy K. Hypopigmentation after triamcinolone
injection for de Quervain tenosynovitis.
American journal of physical medicine & rehabilitation.
2013; 92(7):639.
26. Saour S, Dhillon BS, Ho-Asjoe M, Mohanna PN.
Ascending hypopigmentation of the forearm
following injection of triamcinolone. Journal of
Plastic, Reconstructive & Aesthetic Surgery. 2009;
62(12):e597-8.
27. Nguyen ML, Jones NF. Rupture of both the abductor
pollicis longus and extensor pollicis brevis tendons
after steroid injection for de quervain tenosynovitis.
Plastic and reconstructive surgery. 2012; 129(5):
883e-6e.
28. van der Wijk J, Goubau JF, Mermuys K, van
Hoonacker P, Vanmierlo B, Kerckhove D, et al. Pulley
reconstruction as part of the surgical treatment for de
Quervain disease: surgical technique with mediumterm
results. Journal of wrist surgery. 2015; 4(3):200.
29. Ramesh R, Britton JM. A retinacular sling for subluxing
tendons of the first extensor compartment: A CASE
REPORT. The Journal of Bone and Joint Surgery.
British volume. 2000; 82(3):424-5.
30. McMahon M, Craig SM, Posner MA. Tendon
subluxation after de Quervain’s release: treatment
by brachioradialis tendon flap. The Journal of hand
surgery. 1991; 16(1):30-2.
31. Littler JW, Freedman DM, Malerich MM. Compartment
reconstruction for de Quervain’s disease. Journal of
Hand Surgery. 2002; 27(3):242-4.