Treatment of De Quervain's Tenosynovitis: A Prospective Trial Comparing Non-Surgical Options
Joseph A Ippolito, M.D.; Spencer Hauser, M.D.; Irfan Ahmed, M.D.; Rutgers New Jersey Medical School, Newark, NJ
De Quervain's tenosynovitis, typically diagnosed clinically, is most commonly seen in women 30 to 50 years old and in patients who perform repetitive wrist ulnar deviation with thumb abduction and extension. Nonsurgical treatments of this condition are pursued initially, including rest, oral analgesia, immobilization, and corticosteroid (CSI) injection. Previous studies comparing treatment options have contributed to a lack of consensus regarding ideal nonsurgical management. The purpose of this study was to analyze results in prospectively randomized patients treated with CSI alone versus CSI with immobilization.
The following three pre-treatment symptoms were utilized to define DeQuervain's tenosynovitis in adult patients: radial sided wrist pain, 1st dorsal compartment tenderness, and positive Finkelstein test. Additionally, pain 4 or higher on the Visual Analogue Scale (VAS) was utilized for inclusion in the study. Following exclusion criteria (Figure 1), patients underwent randomization into two groups: (1) CSI alone or (2) CSI with 3 weeks of immobilization with a spica splint or cast. Patients were followed at 3 weeks and 6 months for further evaluation, where resolution of symptoms and improvements in VAS and DASH scores were assessed to evaluate treatment success (Figure 1).
Nine patients with CSI alone and eleven patients with CSI and immobilization were followed. Patient demographic information and pre-treatment symptoms were comparable between groups (Table 1). At six months in both groups 1 and 2, patients experienced significant improvement in VAS scores and DASH scores (p<0.001). Also, 88% of patients with CSI alone and 73% of patients with CSI and immobilization experienced complete resolution of at least two out of three of their pre-treatment symptoms. However, these values were not significantly different (p=0.435). Between groups, all measured outcomes were comparable with the exception of resolution of radial sided wrist pain, which was superior in patients with CSI alone [100% (9/9) vs. 64% (7/11); p=0.043].
Immobilization following injection increases cost of treatment, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Immobilization may also contribute to prolonged radial sided wrist pain in these patients. Further prospective randomized studies with larger sample sizes are warranted.
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