Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial

Ippolito, Joseph A.; Hauser, Spencer; Patel, Jay M.; Vosbikian, Michael M.; Ahmed, Irfan

doi:10.1177/1558944718791187

Cited by 35 publications

(48 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

mentioning

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

View full text Add to dashboard Cite

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.

show abstract

mentioning

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

View full text Add to dashboard Cite

show abstract

“…Prospectively randomized patients treated with either corticosteroid injection (CSI) alone were compared with CSI with immobilization [15]. Radial-sided wrist pain, first dorsal compartment tenderness, and positive Finkelstein test were used to define DQT.…”

Section: Corticosteroid Injection (Csi)/csi + Splint For Dqtmentioning

confidence: 99%

De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment

Mak¹

2019

View full text Add to dashboard Cite

De Quervain's tenosynovitis (DQT) is a repetitive stress condition located at the first dorsal compartment of the wrist at the radial styloid. The extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons and each tendon sheath are inflamed and this may result in thickening of the first dorsal extensor sheath. Workers who perform repetitive activities of the wrist and hand and those who routinely use their thumbs in grasping and pinching motions in a repetitive manner are most susceptible to DQT. Conservative treatments include activity modification, modalities, orthotics, and manual therapy. This chapter identifies, in an evidence base manner through the literature, the most effective diagnostic measures for DQT. It also examines the evidence base on (or lack thereof) the treatment or treatment combinations to reduce pain and improve functional outcomes for patients with DQT.

show abstract

“…Splinting for De Quervain's tenosynovitis has been found to decrease pain while increasing patients' ability to continue to participate in activities of daily living. 15 Wearing splints will assist by preventing aggravating movements of the thumb and wrist that lead to stenosis of the first dorsal compartment, facilitating rest and recovery. 16 The splint must immobilise the wrist and thumb, excluding the thumb interphalangeal joint, in order to offload the APL and EPB tendons.…”

Section: Splintingmentioning

confidence: 99%

“…As a result of the non-inflammatory nature of De Quervain's tenosynovitis, research is now revealing that full-time immobilisation can have detrimental effects on tendon recovery because of the myxoid changes that are present within the tendon substance. 15 Splints should not be used in isolation. Other techniques used by therapists include the following:…”

Section: Splintingmentioning

confidence: 99%

See 1 more Smart Citation

‘The side of my wrist hurts’: De Quervain’s tenosynovitis

Allbrook¹

2019

Aust J Gen Pract

View full text Add to dashboard Cite

show abstract

Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial

Abstract: Immobilization following injection increases costs, may hinder activities of daily living, and did not contribute to improved patient outcomes in this study. Further prospective studies are warranted.

Cited by 35 publications

References 23 publications

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

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

De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment

‘The side of my wrist hurts’: De Quervain’s tenosynovitis

Contact Info

Product

Resources

About