Comparison Of Mid-Term And Short-Term Results Of Ultrasound-Guided Corticosteroid Injection For De Quervain`S Disease Patients With Septate Compartment Between Two Procedures
Junko Sato, MD, PhD1; Yoshinori Ishii, MD, PhD1; Hideo Noguchi, MD1; Ikuko Takahashi, MD2
1Ishii Orthopaedic & Rehabilitation Clinic, Gyoda, Saitama, Japan; 2Ishii orthopedic & Rehabilitation Clinic, Gyoda, Japan
Introduction This study aims to compare the mid-term and short-term results of ultrasound-guided corticosteroid injection (UGCI) for de Quervain`s disease patients with septate first dorsal extensor compartment between two procedures: extensor pollicis brevis (EPB) subcompartment injection with or without additional abductor pollicis longs (APL) subcompartment injection.
Methods Forty-one wrists with septate first dorsal extensor compartment from 39 patients (15 men and 24 women, mean age 54.2±17.4 years) who was initially diagnosed in our clinic and had not undergone any previous treatment were enrolled. Intracompartmental septum was sonographically confirmed at their initial visit. We categorized these wrists into three groups according to treatment: A) UGCI into EPB subcompartment, B) UCGI into EPB and APL subcompartments and C) No UCGI. In each group, the patients’ visual analogue scale (VAS) and quick DASH score (DASH) were compared among three points of time: at the time of injection or diagnosis, 6 and 12 weeks after injection or diagnosis. Among three groups, improvement rate (%) of VAS and DASH were compared similarly at the time of 6- and 12-week. For UCGI, the mixture of triamcinolone acetonide 3mg/0.3ml and 1% mepivacaine 0.7ml was injected with 27G needle proximally from distal side of the compartment using sonographic image in anterograde manner. Halves of it were equally injected into two subcompartments in group B. For statistical analyses, we used the paired t-test for the comparisons in each group and the Student`s t-test among three groups, respectively.
Results We excluded group C from the comparisons at the time of 12-week because of a small amount of data. In group A and B, VAS and DASH at the time of 6 and 12-weeks after injection were significantly lower than those at the time of injection, while there was no significant difference between 6- and 12-week. Group C showed no improvement in VAS and DASH at the time of 6 weeks after diagnosis. With regards to the comparison among three groups, improvement rates of VAS and DASH were significantly higher in group A and B than in group C at the time of 6 and 12-weeks after injection, while there was no significant difference between group A and B at any timing.
Conclusions In corticosteroid injection for de Quervain`s disease patients with septate first dorsal compartment, we might expect good result by injecting focusing only on EPB subcompartment. Small amount of triamcinolone acetonide had been effective for 12 weeks with significance.
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