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Buddle VP, DeBernardis D, Lutsky KF, Beredjiklian PK, Matzon JL. Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. J Hand Surg Am 2022; 47:979-987. [PMID: 35534325 DOI: 10.1016/j.jhsa.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/02/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to determine the effectiveness of corticosteroid injections (CSIs) for de Quervain tenosynovitis in patients with diabetes mellitus. METHODS We retrospectively identified all patients with diabetes receiving a CSI for de Quervain tenosynovitis by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, number and timing of CSIs, and first dorsal compartment release. Success was defined as not undergoing an additional CSI or surgical intervention. The mixture of a corticosteroid and local anesthetic provided in each injection was at the discretion of each individual surgeon. RESULTS Corticosteroid injections were given to 169 wrists in 169 patients with diabetes. Out of 169 patients, 83 (49%) had success following the initial CSI, 44 (66%) following a second CSI, and 6 (67%) following a third CSI. A statistically significant difference was identified in the success rates between the first and second CSIs. Ultimately, 36 of 169 wrists (21%) underwent a first dorsal compartment release. CONCLUSIONS Patients with diabetes mellitus have a decreased probability of success following a single CSI for de Quervain tenosynovitis in comparison to nondiabetic patients, as described in the literature. However, the effectiveness of each additional CSI does not appear to diminish. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Vincent Patrick Buddle
- Department of Orthopaedics, Rowan University School of Osteopathic Medicine, Stratford, NJ.
| | - Dennis DeBernardis
- Department of Orthopaedics, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Kevin F Lutsky
- Department of Orthopedics, The University of Vermont, Burlington, VT
| | | | - Jonas L Matzon
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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Khurana A, Agarwal P, Gupta SC, Malik K, Jain V. Pulley Reconstruction Following Surgical Release of DC1 Pulley in De Quervain's Tenosynovitis: Surgical Technique and Case Series. Arch Bone Jt Surg 2022; 10:459-465. [PMID: 35755793 PMCID: PMC9194712 DOI: 10.22038/abjs.2021.58872.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
De Quervain's disease (DQD) is tenosynovitis of the first dorsal compartment (DC1) of the wrist between the osteofibrous tunnel and the tendons involving the APL and EPB sheaths at the radial styloid. Surgical intervention is indicated when pain does not resolve despite 3 to 6 months of conservative management. Release of the first dorsal compartment is an effective treatment of DQD. In addition to surgical release, we performed pulley reconstruction using a new technique in the present series of 20 patients which has not been previously described with a followup of over 1 year. All patients showed a consistent improvement in VAS score at over one year followup with resolution of Finkelstein, Eichoff and WHAT test. Only one temporary neuropraxia was encountered due to stretching/scar entrapment of superficial branch of radial nerve. Our innovative technique of pulley reconstruction is not only easy to understand and perform but has shown consistent result in the 20 cases operated with this technique with a follow up of at least 1 year. The technique has the distinct advantage of having a quick learning curve and gives reliable, lasting results without complications or recurrence.
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Pratik Agarwal
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | | | - Kuldeep Malik
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Vishal Jain
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
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Pirola I, Gandossi E, Rotondi M, Marini F, Cristiano A, Chiovato L, Castellano M, Ferlin A, Cappelli C. Incidence of De Quervain's thyroiditis during the COVID-19 pandemic in an area heavily affected by Sars-CoV-2 infection. Endocrine 2021; 74:215-218. [PMID: 34363586 PMCID: PMC8349140 DOI: 10.1007/s12020-021-02841-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the possible association between Covid-19 infection and subacute thyroiditis. METHODS We reviewed the medical and imaging records of patients referred to our Department's outpatient setting dedicated to 'thyroid emergency' (records with a 'bollino verde'-green sticker, classifed as urgent) from April 2020 to October 2020. This outpatient clinic is devoted to patients requiring evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly-diagnosed subacute thyroiditis were selected. The data of all patients receiving a diagnosis of subacute thyroiditis was collected retrospectively, taking into account the same period of time (April-October) and starting from 2016. RESULTS During the COVID-19 outbreak in our region (April 2020 to October 2020) 396 patients attended the outpatient emergency clinic. Among them, 10 (2.5%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44-year-old man, a COVID-19 pulmonary infection had been diagnosed 7 weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and remain COVID-19 free as confirmed by telephone interview. The percentage of patients who received a diagnosis of subacute thyroiditis in the same period starting from 2016 was very similar (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively). CONCLUSIONS Our data do not show an increase in the incidence of subacute thyroiditis in the Brescia area, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, ASST Spedali Civili di Brescia, University of Brescia, 25123, Brescia, Italy.
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Salim B, Ansari MT, Kumar VS, Goyal A, Malhotra R. Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial. J Wrist Surg 2021; 10:377-384. [PMID: 34631289 PMCID: PMC8489986 DOI: 10.1055/s-0041-1725171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/21/2021] [Indexed: 12/16/2022]
Abstract
Purpose The aim of this study was to compare the results of surgeries of the De Quervain's disease (DQD) through a randomized control trial. Materials and Methods We treated 40 cases of De Quervain's tenosynovitis in 2 groups: 20 patients by pulley release method and another 20 patients by pulley reconstruction method. The patients were selected as per the random table number. The clinical data, numeric Visual Analogue Scale (VAS) score, Quick DASH-Disabilities of the Arm, Shoulder, and Hand-score, Mayo Wrist Score, and subluxation of the tendons in dynamic ultrasonography (USG) during wrist hyperflexion and abduction of the thumb test were noted preoperatively and 6 months after the operation. All patient charts were reviewed and data analysis was done after completion of the study. Results All patients improved after surgery. There was no difference in clinical outcome data, numeric VAS score, Quick DASH Score, and Mayo Wrist Score ( p -value > 0.05). There were four patients with tendon subluxation under USG in pulley release group, out of which only one patient was clinically symptomatic. There was no tendon subluxation in pulley reconstruction group. The tendon subluxation between the two groups was not found to be statistically significant ( p -value: 0.661). Conclusion Although, higher numbers of subluxation were found in release group, there was no statistically significant difference in the outcome of the two surgical procedures for DQD. This study is a pilot study, and it may act as the groundwork over which further studies may be performed. Level of Evidence This is a Level I study.
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Affiliation(s)
- Burhan Salim
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Stephens AR, Yu Z, Presson AP, Tyser AR, Kazmers NH. Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery. J Wrist Surg 2020; 9:289-297. [PMID: 32760607 PMCID: PMC7395842 DOI: 10.1055/s-0040-1708863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/13/2020] [Indexed: 12/26/2022]
Abstract
Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal-Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t -test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.
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Affiliation(s)
- Andrew R. Stephens
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Ziji Yu
- Division of Public Health, University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Division of Public Health, University of Utah, Salt Lake City, Utah
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah
| | - Andrew R. Tyser
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Nikolas H. Kazmers
- School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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Beutel BG, Doscher ME, Melone CP. Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study. Hand (N Y) 2020; 15:348-352. [PMID: 30428712 PMCID: PMC7225884 DOI: 10.1177/1558944718810864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The reported prevalence of a subcompartment housing the extensor pollicis brevis (EPB) tendon within the first dorsal compartment varies widely in the literature, especially regarding the rates of occurrence between genders and among those with and without De Quervain. Based on direct intraoperative observation, we hypothesized that the prevalence of a septated compartment is far greater than previously reported, particularly in those with De Quervain disease. Methods: A prospective analysis of consecutive patients who underwent first dorsal compartment release was carried out. Patients were divided into 2 groups: those with De Quervain tenosynovitis ("De Quervain" group) and a control cohort without a primary diagnosis of De Quervain ("non-De Quervain" group). The intraoperative findings of a single compartment or a separate subcompartment were recorded. The prevalence of a septated compartment was calculated and compared between genders and both patient groups. Results: A total of 102 consecutive patients were included, with a female predominance (74.5%). Overall, 79.4% of patients had a separate subcompartment for the EPB. In the De Quervain cohort, 89.1% had 2 compartments, while 71.4% of non-De Quervain patients had a subcompartment. Men and women had a similar rate of double compartments (80% and 82.4%, respectively). Conclusions: The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients afflicted with De Quervain tenosynovitis. This higher rate of septation occurs with a similar prevalence in both men and women. Owing to its consistent presence, the dual first dorsal compartment should be regarded as an expectant anatomical component of the normal wrist.
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Affiliation(s)
- Bryan G. Beutel
- Mount Sinai Beth Israel, New York, NY, USA,Bryan G. Beutel, Department of Orthopaedic Surgery, The Hand Surgery Center, Mount Sinai Beth Israel, 321 East 34th Street, New York, NY 10016, USA.
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Mangukiya HJ, Kale A, Mahajan NP, Ramteke U, Manna J. Functional outcome of De Quervain's tenosynovitis with longitudinal incision in surgically treated patients. Musculoskelet Surg 2019; 103:269-73. [PMID: 30600438 DOI: 10.1007/s12306-018-0585-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION De Quervain described tenosynovitis of first dorsal compartment more than 120 years ago. Women, particularly of 4th-5th decades, are at more risk of developing disease. Steroid injection has been described as first line of management over many decades, but it is associated with some significant complications like depigmentation of skin, atrophy of subcutaneous tissue, suppurative tenosynovitis and even tendon rupture. Animal studies have also reported increased risk of peritendinous adhesions with steroid injection. MATERIALS AND METHODS We prospectively managed 46 cases of De Quervain's tenosynovitis with longitudinal incision at tertiary care hospital from 2014 to 2016. There were totally 40 patients with 9 males and 31 females between age group of 28 and 62 years. All patients were evaluated using DASH and VAS scores preoperatively and post-operatively. RESULTS The mean preoperative DASH score was 42.26 which reduced to 5.37 post-operatively. The mean preoperative VAS score was 7.30 which reduced to 2.33 post-operatively. Intraoperatively, we found peritendinous adhesions in 8 patients and ganglion arising from first dorsal compartment in one patient. Post-operatively, we found hypertrophic scar in 3 patients and persistent numbness to first dorsal web space due to injury to superficial radial nerve in 2 patients. Six patients had recurrent symptoms and required revision surgery. CONCLUSION Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons.
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Abstract
BACKGROUND The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. METHODS Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. RESULTS The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful. CONCLUSION Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.
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Affiliation(s)
- Philip To
- OrthoArizona, Scottsdale, USA,Philip To, OrthoArizona, 5620 E. Bell Road, Scottsdale, AZ 85254, USA.
| | | | | | | | - Mohab Foad
- Beacon Orthopaedics and Sports Medicine, Cincinnati, OH, USA
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Perno-Ioanna D, Papaloïzos M. A comprehensive approach including a new enlargement technique to prevent complications after De Quervain tendinopathy surgery. Hand Surg Rehabil 2016; 35:183-189. [PMID: 27740460 DOI: 10.1016/j.hansur.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/18/2016] [Accepted: 03/17/2016] [Indexed: 01/14/2023]
Abstract
The goal of this study was to evaluate the outcome of our surgical approach aimed at preventing complications following surgery for De Quervain tendinopathy. Our stepwise surgical procedure is described in detail. We reviewed 56 cases operated by a senior surgeon over 5years, and re-evaluated them with a minimum 15months' follow-up. Complications mentioned in the literature (poor wound healing, adhesions, nerve injury, incomplete decompression, tendon subluxation) were not present in any of the cases; the satisfaction rate was very high. Slight residual discomfort was noted in 16 cases. Among them, 13 had an associated pathology. In summary, the outcome after the comprehensive approach presented here is highly predictable. Properly applied, good to excellent results can be expected in most patients. Potential postoperative complications are effectively prevented. Some caution is needed in cases of associated pathologies.
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Affiliation(s)
- D Perno-Ioanna
- CH8, Center for Hand Surgery and Therapy, Charles-Humbert 8, 1205 Geneva, Switzerland
| | - M Papaloïzos
- CH8, Center for Hand Surgery and Therapy, Charles-Humbert 8, 1205 Geneva, Switzerland.
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Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J 2015; 9:456-9. [PMID: 27468839 PMCID: PMC4645863 DOI: 10.2174/1874325001509010456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/12/2015] [Accepted: 08/05/2015] [Indexed: 12/28/2022] Open
Abstract
De Quervain's stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group.Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.
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Affiliation(s)
- Patrick Rowland
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Nigel Phelan
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Sean Gardiner
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Kenneth N Linton
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
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Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J 2015; 9:437-44. [PMID: 26587059 PMCID: PMC4655850 DOI: 10.2174/1874325001509010437] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022] Open
Abstract
De Quervain’s stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group. Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.
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Affiliation(s)
- Patrick Rowland
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Nigel Phelan
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Sean Gardiner
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - Kenneth N Linton
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - Rose Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
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Hajder E, de Jonge MC, van der Horst CMAM, Obdeijn MC. The role of ultrasound-guided triamcinolone injection in the treatment of de Quervain's disease: treatment and a diagnostic tool? ACTA ACUST UNITED AC 2013; 32:403-7. [PMID: 24139754 DOI: 10.1016/j.main.2013.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/23/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to describe the technique and usefulness of ultrasound-guided intrasheath injection of triamcinolone in the treatment of de Quervain's disease (dQD). Our study was retrospective in design. Seventy-one wrists of 62 patients who were treated with an ultrasound-guided triamcinolone injection for dQD were included. A literature search was performed to compare our results. In the literature we found supportive evidence that accurate injection of triamcinolone in the first dorsal compartment of the wrist is important for a good outcome. In this retrospective study we found that treatment with ultrasound-guided injections of triamcinolone is both safe and effective. After two injections, 91% of the patients had good long-term results, which is a higher cure rate than found in most other studies. Furthermore, we found that Finkelstein's test can give a false positive result. Therefore, ultrasound should not only be considered to improve the treatment outcome, but can also be useful as a diagnostic tool in the management of de Quervain's disease.
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Affiliation(s)
- E Hajder
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
| | - M C de Jonge
- Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands
| | - C M A M van der Horst
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
| | - M C Obdeijn
- Academic Medical Center, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands.
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