Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis

Oh, Jinhee K.; Messing, Susan; Hyrien, Ollivier; Hammert, Warren C.

doi:10.1177/1558944716681976

Cited by 40 publications

(43 citation statements)

References 15 publications

(21 reference statements)

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“…However, this correlation may be elucidated by determining the levels of tissue inflammation in these three phases, based on the report by Kuo et al , which indicate that tissue inflammation and angiogenesis in de Quervain's disease is directly related to the severity and progression of the disease. [2] In this study, the proportion of patients that were completely free of symptom and sign after the initial injection is comparable to 71% reported by Harvey et al ,[5] but very different from 58% and 51% by Anderson et al [11] and Oh et al ,[12] respectively. The reasons for these variations in the rate of complete and successful response with one injection of corticosteroid are also not evident.…”

Section: Discussionsupporting

confidence: 78%

“…[11] However, in published reports, the cure rate for local corticosteroid injection varies from 66% to 99%. [571011121314] The cure rate of de Quervain's disease treated with local corticosteroid injection is mainly dependent on the accuracy of injection into the fibro-osseous canal. [13] Anatomical variation of the fibro-osseous canal that also varies in incidence (9.8%-61-8%)[151617] is one of the most important factors in the accuracy of the injection;[14] it also accounted for over 90% of cases that failed to respond to local corticosteroid injection in the series reported by Harvey et al [5]…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome of nonoperative treatment of de Quervain's disease with local corticosteroid injection in Nigerian setting

Omoke

Nnadozie

2019

Niger J Surg

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Background:The goal of treatment of de Quervain's disease, pain relief and restoration of hand functions, is achievable with local corticosteroid injection. However, published reports indicate variations in its cure rate and efficacy from and within subregions. This study aimed to determine the outcome of this treatment modality in Nigerian setting.Patients and Methods:Fifty-one cases of de Quervain's disease in 41 consecutive eligible patients were enrolled between January 2011 and December 2016, treated with local methylprednisolone acetate injection and followed up prospectively in orthopedic clinics of Federal Teaching Hospital, Abakaliki, and Mater Miserere Cordiae Hospital, Afikpo, Nigeria.Results:Eight weeks post initial injection, 94% of the cases were signs and symptoms free. The recurrence rate post initial injection (19.6%) correlated directly with pain intensity (P < 0.001) and was significantly (P = 0.018) higher in subacute compared to acute and chronic presentations. At the end of a follow-up period that ranged from 24 to 84 months with a mean of 54 months, 47 (92.2%) cases were cured with either single injection (78.4%) or multiple injections (13.7%) of corticosteroid, 3 (5.9%) had incomplete resolution but were satisfied, and in 1 (2%) there was no beneficial response. There was no serious adverse reaction; 14 (27.5%) cases had localized skin depigmentation.Conclusion:In our setting, local corticosteroid injection as a treatment modality for de Quervain's tenosynovitis has short- and long-term success rates of over 90%, and is rarely associated with serious adverse reaction. It is recommended as the initial treatment of choice in de Quervain's disease.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Clinical outcome of nonoperative treatment of de Quervain's disease with local corticosteroid injection in Nigerian setting

Omoke

Nnadozie

2019

Niger J Surg

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“…De Quervain's tenosynovitis causes radial wrist pain that increases with activity (2). Steroid injection into the tendon sheath is a standard method as a primary treatment in uncomplicated cases (3). Although steroid injection is common, complications such as subcutaneous atrophy, fat necrosis, weakening or rupture of tendons, and depigmentation have been reported after this treatment regimen (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Steroid Injection Versus Open Surgery in the Treatment of De Quervain’s Tenosynovitis

Acar¹,

Memik²

2019

Eurasian J Emerg Med

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A total of 82 patients (65 females, 17 males) who were admitted between January 2013 and April 2015 were homogeneously divided into two equal groups. There were 42 patients (35 females, 7 males) in the first group and 40 patients (30 females, AbstractAim: This study aimed to compare steroid injection and open surgery in the treatment of De Quervain's tenosynovitis. , a total of 82 patients (65 females, 17 males; mean age=40.3 years; range, 20 to 71 years) who were admitted were included retrospectively. The patients were assigned into two groups, including group I undergoing open surgery, and group II receiving steroid injections. The rates of recurrence and satisfaction were evaluated. The patients undergoing surgery were also evaluated for the wound site infection, nerve injury, wound opening, and limited range of motions of the joints. The patients receiving steroid injections were evaluated for subcutaneous atrophy, fat necrosis, weakening or rupture of tendons, and depigmentation. Results:The mean follow-up was 12 months (range: 6 to 22). Recurrence occurred in eight patients (20%) in the steroid injection group; however, no recurrence was seen in patients undergoing open surgery. Satisfactory or very satisfactory results were achieved in all patients in the surgery group (p=0.04). There were no complications in both groups. Conclusion:Although steroid injection is a therapeutic option in De Quervain's tenosynovitis, open surgery appears to be a more beneficial method with relatively low recurrence and complication rates.

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“…DQR is reserved for selected patients with ongoing pain and decreased function despite maximized nonoperative treatment. [3][4][5] Substantial efforts have previously been made to assess clinical outcomes following DQR, [6][7][8][9][10] although prior work elucidating factors that influence surgical treatment costs is lacking in the current literature. Such information may help to guide treatment of patients with De Quervain tendinopathy, as the treating surgeon has several treatment choices to consider when surgically treating indicated patients.…”

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confidence: 99%

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

Stephens

Presson

et al. 2020

J Wrist Surg

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Background First extensor compartment release is a common surgical procedure that represents a financial burden to the health care system. Questions/Purposes Study questions included (1) whether surgical encounter costs differ based upon surgical setting (operating room [OR] vs. procedure room [PR]) or (2) based upon anesthesia choice (local only, Bier's block [BB], monitored anesthesia care [MAC], or general [GA]) for De Quervain release (DQR). Patients and Methods Consecutive adult patients undergoing isolated unilateral DQR at a single academic medical center were identified retrospectively by Current Procedural Terminology code (25000). Using our institution's information technology value tools, we calculated total direct costs for each surgical encounter. Costs were adjusted to January 2016 dollars using the Consumer Price Index, normalized using each participant's surgical encounter cost divided by the median cost in the PR group, then compared across each group using Kruskal–Wallis and Nemenyi's post hoc pair-wise tests. Multivariable gamma regression analysis with a log link was performed to identify factors associated with surgical costs. QuickDASH (disabilities of the arm, shoulder, and the hand) scores were compared using a t-test at final follow-up. Results Among 58 included patients, 29% (17/58) were treated in the PR and 71% (41/58) in the OR. Compared with local only in the PR, all other groups were significantly more costly. Multivariable gamma regression indicated that use of OR/BB, OR/MAC, or OR/GA independently led to 211, 222, and 357% greater surgical costs as compared with the PR with local only while controlling for provider and patient age. Furthermore, QuickDASH scores were similar between PR and OR groups at final follow-up. Conclusion Performing DQR in the PR setting under local only anesthesia yields greater value than the OR, as patient-reported outcomes are similar despite significantly lower surgical costs. Level of Evidence This is a Level III, cost analysis study.

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Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis

Abstract: This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. This study also suggests that female sex and BMI >30 are associated with increased treatment failure.

Cited by 40 publications

References 15 publications

Clinical outcome of nonoperative treatment of de Quervain's disease with local corticosteroid injection in Nigerian setting

Clinical outcome of nonoperative treatment of de Quervain's disease with local corticosteroid injection in Nigerian setting

Steroid Injection Versus Open Surgery in the Treatment of De Quervain’s Tenosynovitis

Cost Implications of Varying the Surgical Setting and Anesthesia Type for De Quervain Release Surgery

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