Methylprednisolone Acetate Injection with Casting versus Casting alone for the Treatment of De-Quervain's Tenosynovitis: a randomized controlled trail

Akhtar, Muhammad Saeed; Gillani, Syed Faraz Ul Hassan Shah; Nadeem, Rana Dilawaiz; Tasneem, Muhammad

doi:10.5455/jpma.293180

Cited by 5 publications

(10 citation statements)

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“…A total of 37 studies were initially found to be eligible. Of those, 7 studies did not include 1 of our predefined outcome measures or included patients with conditions other than DQT and did not analyze data separately and were therefore excluded (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 17 studies were included in network meta-analyses, which were performed separately for short-term pain (15 studies; 14 interventions), mid-term pain (9 studies; 7 interventions), short-term function (8 studies; 7 interventions), and mid-term function (6 studies; 3 interventions). eFigures 17 through 20 in Supplement 1 show the comparative treatment class effects for short-term pain, mid-term pain, short-term function, and mid-term function.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 17 studies [16][17][18]21,24,25,27,29,[35][36][37][38][39][41][42][43]45 were included in network meta-analyses, which were performed separately for short-term pain (15 studies [16][17][18]21,24,25,27,29,[35][36][37][38][39]41,43,45 ; 14 interventions), mid-term pain (9 studies 17,18,25,27,35,37,[41][42][43] ; 7 interventions), short-term function (8 studies 24,25,27,[35][36][37]41,43 ; 7 interventions), and mid-term function (6 studies 25,…”

Section: Network Meta-analysesmentioning

confidence: 99%

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Management of de Quervain Tenosynovitis

Challoumas,

Ramasubbu,

Rooney

et al. 2023

JAMA Netw Open

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ImportanceThere is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.ObjectiveTo assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.Data SourcesMedline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.Study SelectionAll randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.Data Extraction and SynthesisThis study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.Main Outcomes and MeasuresPairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.ResultsA total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.Conclusions and RelevanceThis network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Network Meta-analysesmentioning

confidence: 99%

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Management of de Quervain Tenosynovitis

Challoumas,

Ramasubbu,

Rooney

et al. 2023

JAMA Netw Open

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“…Additionally, to assess the patient's improvement, the treating orthopaedic surgeon will subjectively evaluate the patient's ability to return to their normal activities of daily living. For instance, can the patient pick up a cup of coffee or their child without pain [21][22][23][24].…”

Section: Clinical Outcomesmentioning

confidence: 99%

Clinical Implications and Treatment Algorithm for Patients with de Quervain’s Tenosynovitis

Pearson¹

2022

GJOR

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Purpose: De Quervain's tenosynovitis can be a debilitating condition affecting the first dorsal compartment of the wrist. Depending on the severity, patients experiencing this pathology often lose significant functionality in the affected wrist. Upon diagnosis, non-surgical treatment is the standard of care, but failure of conservative treatments can lead to the need for surgical intervention. The main purpose of this study was to report the clinical implications and treatment algorithm for patients presenting with de Quervain's tenosynovitis. The secondary purpose was to report clinical differences in patients that chose surgical intervention following conservative management for de Quervain's tenosynovitis.Methods: Following initial consultation with the treating orthopedic surgeon and throughout the conservative management time frame, 240 injuries (93%) were splinted, 230 (89%) patients were given an oral NSAID, and patients spent an average of 12 ± 6.9 weeks in occupational therapy for treatment of their injuries. In addition, 165 (64%) received an initial cortisone injection into the first dorsal extensor tendon compartment of the wrist. 44-Forty-four (17%) of these patients received a second cortisone injection, and 6 (2%) received a third cortisone injection with at least 2 to 3 months between each injection.Result: Our study found that following conservative management there was significant improvement in the severity of symptoms, which was recorded using visual analog scale (VAS) scores. However, 58 (22%) patients converted to surgical release for de Quervain's tenosynovitis, reported a higher post-management severity of symptoms (p<.001) than the patients who were solely treated conservatively.Conclusions: Patients showed significant improvement following conservative treatment, such as splinting, NSAIDs, occupational therapy and corticosteroid injections. This study also confirms that patients who are surgically treated are associated with higher pain levels post-conservative treatment and post-management than those solely treated conservatively. Finally, this data suggests that those patients in this patient population who experience de Quervain's tenosynovitis through traumatic onset are more likely to require surgical intervention.

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“…This is performed to mitigate pain and increase the patient's range of motion. [4][5][6] Although clinical research indicates that corticosteroid injection can alleviate inflammation and pain, 7 such treatment can lead to impaired supraspinatus tenocyte function and a high tendon rerupture rate. 8 Lidocaine is a local anesthetic that can block nociceptive impulses through the inhibition of voltage-gated sodium channels.…”

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confidence: 99%

Lidocaine inhibits migration of tenocytes by downregulating focal adhesion kinase and paxillin phosphorylation

Chang,

Chen,

et al. 2023

Journal Orthopaedic Research

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Lidocaine is the most frequently applied local infiltration anesthetic agent for treating tendinopathies. However, studies have discovered lidocaine to negatively affect tendon healing. In the current study, the molecular mechanisms and effects of lidocaine on tenocyte migration were evaluated. We treated tenocytes intrinsic to the Achilles tendons of Sprague–Dawley rats with lidocaine. The migration ability of cells was analyzed using electric cell‐substrate impedance sensing (ECIS) and scratch wound assay. We then used a microscope to evaluate the cell spread. We assessed filamentous actin (F‐actin) cytoskeleton formation through immunofluorescence staining. In addition, we used Western blot analysis to analyze the expression of phospho‐focal adhesion kinase (FAK), FAK, phospho‐paxillin, paxillin, and F‐actin. We discovered that lidocaine had an inhibitory effect on the migration of tenocytes in the scratch wound assay and on the ECIS chip. Lidocaine treatment suppressed cell spreading and changed the cell morphology and F‐actin distribution. Lidocaine reduced F‐actin formation in the tenocyte during cell spreading; furthermore, it inhibited phospho‐FAK, F‐actin, and phospho‐paxillin expression in the tenocytes. Our study revealed that lidocaine inhibits the spread and migration of tenocytes. The molecular mechanism potentially underlying this effect is downregulation of F‐actin, phospho‐FAK, and phospho‐paxillin expression when cells are treated with lidocaine.

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Methylprednisolone Acetate Injection with Casting versus Casting alone for the Treatment of De-Quervain's Tenosynovitis: a randomized controlled trail

Cited by 5 publications

References 0 publications

Management of de Quervain Tenosynovitis

Management of de Quervain Tenosynovitis

Clinical Implications and Treatment Algorithm for Patients with de Quervain’s Tenosynovitis

Lidocaine inhibits migration of tenocytes by downregulating focal adhesion kinase and paxillin phosphorylation

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