Testosterone Replacement Therapy is Associated with Increased Rates of Trigger Finger and De Quervainâ€™s Tenosynovitis with Increased Rates of Requiring Surgical Release
J. Alex Albright, BS1, Patrick S Barhouse, BS1, Elliott Rebello, BS1, Kenny Chang, BS1, Matthew S Quinn, MD1, Joseph A Gil, MD2, Alan H Daniels, MD3 and Michel A. Arcand, MD1, (1)Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, (3)Brown University, Warren Alpert Medical School, Providence, RI
Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tendinitis within the hand. The purpose of this study is to establish an association between TRT use and hand tenosynovitis by evaluating the rates of trigger finger and De Quervainâ€™s tenosynovitis in patients undergoing TRT and comparing them to matched controls.
This is a one-to-one exact matched retrospective study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for three consecutive months. These patients were matched on age, sex, and Charlson comorbidity index to a randomly generated control. Rates of new-onset trigger finger and De Quervainâ€™s tenosynovitis and subsequent surgery were identified using ICD-9, ICD-10, and CPT billing codes. Incidence rates were calculated over a two-year period and reported per 10,000 person-years. Single-variable Chi-square analyses and multiple-variable logistic regression were used to compare rates while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison.
Following matching, 430,650 patients comprised both cohorts. Among the TRT cohort, the incidence of trigger finger and De Quervainâ€™s tenosynovitis was 51.9 per 10,000 person-years (95% CI, 50.5 â€“ 53.5) and 13.3 (95% CI, 12.5 â€“ 14.1), respectively, compared to 21.4 (95% CI, 20.4 â€“ 22.4) and 6.2 (95% CI, 5.7 â€“ 6.8) in the control cohort. Patientsundergoing TRT were more likely to develop trigger finger within 1 year (adjusted odds ratio (aOR) = 2.20, 95% confidence interval (CI), 2.02-2.40) and within 2 years (aOR = 1.70, 95% CI, 1.59-1.82) compared to their matched controls. TRT was also associated with an increased likelihood of experiencing DeQuervainâ€™s tenosynovitis within 1 year (aOR = 1.72, 95% CI, 1.46-2.03) and 2 years (aOR = 1.56, 95% CI, 1.38-1.76). Of the patients diagnosed with either condition over the two-year period, patients with prior TRT were over twice as likely to require surgical release for both trigger finger (aOR = 2.10, 95% CI, 1.68-2.63) and De Quervainâ€™s tenosynovitis (aOR = 2.02, 95%CI, 1.15-3.68).
TRT is associated with an increased likelihood of both trigger finger and De Quervainâ€™s tenosynovitis, and an increased likelihood of requiring surgical release for both. These results elucidate the potential clinical consequences of persistent TRT use and provide insight to physicians when counseling patients about the potential risks of TRT.
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