Abstract

BACKGROUND
There is no consensus in the treatment of de Quervain's tenosynovitis, but wrist support with or without local corticosteroid injection has been considered as an effective treatment modality. Some patients have expressed reluctance for steroid injections because of the fear of probable adverse reactions. This study was performed to compare the outcome of methylprednisolone acetate injection plus thumb spica cast versus cast alone for the treatment of de Quervain's tenosynovitis.
METHODS
This randomized prospective study was conducted from January 2005 to July 2008 in the orthopedic clinics of our hospital and private offices. A total of 73 patients with de Quervain's tenosynovitis were managed with either of these methods: 1) injection of methylpredmisolone acetate in the first dorsal compartment of the wrist followed by wrist thumb spica cast. 2) casting alone. Wrist casting duration in both groups was one month and the patients were followed for 6 months.
RESULTS
In the first group, a total of 37 patients were included (injection plus wrist immobilization by cast), and 36 patients in the second group (wrist casting alone). The mean age was 32.6 years (21 - 61 years) in all patients. There were 63 women and 10 men. Overall success rate was 86.5% in the first and 36.1% 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. Despite this adverse reaction which was related to methylprednisolone injection, a higher success rate was seen in the injection group in comparison to patients treated solely by casting.
CONCLUSION
Support of the wrist with casting alone had less favorable outcome in de Quervain's tenosynovitis. Adding methylprednisolone acetate injection into the first dorsal compartment of the wrist is necessary for more optimal results.

Links

Publisher Full Text

Authors

Mehdinasab SA, Alemohammad SA

Institution

Department of Orthopedic Surgery, Imam Khomeini Hospital, Jondishapur University of Medical Sciences, Ahwaz, Iran. hmehdinasab@yahoo.com

Source

Archives of Iranian medicine 13:4 2010 Jul pg 270-4

MeSH

Adult
Anti-Inflammatory Agents
Casts, Surgical
De Quervain Disease
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Injections, Intralesional
Male
Methylprednisolone
Middle Aged
Pain
Pain Measurement
Prospective Studies
Time Factors
Treatment Outcome
Wrist
Young Adult

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20597558