A comparative study between splinting versus corticosteroid injection in de-quervain’s disease

Abstract

Background: de Quervain's disease (DQ) is painful tenosynovitis of first dorsal compartment of hand. It is usually caused by overuse or repetitive activity. There are various modalities of treatment of DQ. Different studies have shown effectiveness of local corticosteroid injection, splinting or both in western population but to our knowledge, there is no effectiveness data available for Indian population. This study was performed to compare the outcome of corticosteroid injection versus splinting for the treatment of de Quervain's tenosynovitis. Methods: This randomized prospective study was conducted from July 2015 to December 2016 in Orthopaedics OPD of RKMSP.A total of 100 patients with de-Quervain's tenosynovitis were treated with either of these methods1) corticosteroid injection in first dorsal compartment of wrist, 2) splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel. Treatment effectiveness was measured by Wong-Baker FACES Pain Rating Scale, 0-10 Numeric Pain Rating Scale, size of nodule over radial styloid and grading of tenderness over 1st dorsal compartment. Results: In the first group, a total of 50 patients were included (corticosteroid injection), and 50 patients in the second group (splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel). The mean age was 32.6 years (21 -61 years) in all patients. There were 90 women and 10 men. Overall success rate was 90% in the first and 60% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P<0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in 40% of patients. Conclusion:Though steroid injection has excellent outcome, splinting can be an alternative viable treatment option for dQ especially in patients with low grade disease or reluctant to injection because of fear of probable adverse reactions.

Ultrasonographic evaluation of anatomical variations, of the first dorsal compartment of wrist, and its correlation with de Quervain’s disease recurrence in Indian population: a hospital based longitudinal study

“…Also concomitant splinting after corticosteroid injection does not yield any added benefit. 23 Cadaveric studies have shown the anatomical proximity between the superficial branch of radial nerve and the tendons of the first dorsal compartment of the wrist. It has been recommended that the EPB tendon, which has a low percentage of overlap with the nerve based on studies, be palpated before injection.…”

Comparison of Efficacy of Injectable Steroids Versus Conservative Management for De Quervains’s Tenosynovitis

“…Keeping in mind the importance of hand use in our daily life and ailment of DQT, its associated effects, we planned to address this issue in our local setting as there is no previous research on this topic from our settings [7] . At current, both operative and non-operative, management of DQT is done [8] . However, no first line or priority method is followed.…”