Treatment of De Quervain Disease With Triamcinolone Injection With or Without Nimesulide

Extra-Articular Steroid Injection: Early Patient Response and the Incidence of Flare Reaction

“…The authors felt that the incidence of flare reactions was less with long-acting steroid esters compared with hydrocortisone acetate. Flare reactions, or a delayed postinjection transient increase in pain, after extra-articular steroid injections rarely have been reported 16 ; however, we feel flare reactions are a common clinical issue.…”

Nonsurgical Treatment for de Quervain's Tenosynovitis

“…The success rate with injections of various corticosteroid formulations ranges from 62% to 93% (Table 1). [3][4][5][6][7][8][9] McKenzie speculated that accurate placement of the corticosteroid within the tendon sheath of the first dorsal compartment, confirmed by free flow of the medicine through the syringe and visible filling of the tendon sheath, was important. 3 In a prospective study of 19 patients, Zingas et al studied the accuracy of injections into the first dorsal compartment with x-ray dyes and determined that although the dye was confirmed within the overall compartment in 84% of cases, only 31% of the time was the separate EPB compartment adequately infiltrated.…”

“…8,9 Jirarattanaphochai et al found no benefit to adding nimesulide, a selective cyclooxygenase-2 inhibitor, to corticosteroid injection in a randomized, double-blinded prospective study. 9 From the Temple Hand Center, Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA.…”

“…According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis [3][4][5][6][7][8][9] and is therefore my preferred initial treatment. I occasionally advise patients with substantial discomfort to use a splint for palliation.…”

Tendon Disorders of the Hand and Wrist

“…A recent randomized, double-blind trial including 160 patients did not demonstrate any additional benefit to the supplemental administration of an oral nonsteroidal antiinflammatory agent. 21 Failure to release a separate subsheath within the first dorsal compartment has been shown to negatively affect surgical outcome; it would seem that efforts to reposition the needle in order to specifically infiltrate the space surrounding both abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons might be associated with higher success rates following injection for de Quervain's disease. 22 Despite our familiarity with corticosteroid injections in the treatment of these tendon disorders and their generally good results, several pieces of this puzzle are still missing.…”