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Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice.

Abstract

BACKGROUND

De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed.

METHODS

Participants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections) were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA) or 1 ml of NaCl 0.9% (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF).

RESULTS

11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015), perceived improvement (78% vs. 33%; p = 0.047) and severity of pain (4.27 vs. 1.33; p = 0.031) but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112). Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76) with a number needed to treat of 2 (95% CI: 1, 3). In the cohort of steroid responders (n = 12) the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67) and scores of Dutch AIMS-2-HFF (p = 0.36), but not for patient perceived improvement (p = 0.02). No adverse events were observed during the 12 months of follow-up.

CONCLUSION

One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. The short-term beneficial effects of steroid injections for symptoms were maintained during the follow-up after 12 months.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN53171398.

Authors+Show Affiliations

Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands. raju@dds.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19860883

Citation

Peters-Veluthamaningal, Cyriac, et al. "Randomised Controlled Trial of Local Corticosteroid Injections for De Quervain's Tenosynovitis in General Practice." BMC Musculoskeletal Disorders, vol. 10, 2009, p. 131.
Peters-Veluthamaningal C, Winters JC, Groenier KH, et al. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskelet Disord. 2009;10:131.
Peters-Veluthamaningal, C., Winters, J. C., Groenier, K. H., & Meyboom-DeJong, B. (2009). Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders, 10, p. 131. doi:10.1186/1471-2474-10-131.
Peters-Veluthamaningal C, et al. Randomised Controlled Trial of Local Corticosteroid Injections for De Quervain's Tenosynovitis in General Practice. BMC Musculoskelet Disord. 2009 Oct 27;10:131. PubMed PMID: 19860883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. AU - Peters-Veluthamaningal,Cyriac, AU - Winters,Jan C, AU - Groenier,Klaas H, AU - Meyboom-DeJong,Betty, Y1 - 2009/10/27/ PY - 2009/02/05/received PY - 2009/10/27/accepted PY - 2009/10/29/entrez PY - 2009/10/29/pubmed PY - 2010/2/18/medline SP - 131 EP - 131 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 10 N2 - BACKGROUND: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed. METHODS: Participants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections) were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA) or 1 ml of NaCl 0.9% (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF). RESULTS: 11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015), perceived improvement (78% vs. 33%; p = 0.047) and severity of pain (4.27 vs. 1.33; p = 0.031) but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112). Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76) with a number needed to treat of 2 (95% CI: 1, 3). In the cohort of steroid responders (n = 12) the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67) and scores of Dutch AIMS-2-HFF (p = 0.36), but not for patient perceived improvement (p = 0.02). No adverse events were observed during the 12 months of follow-up. CONCLUSION: One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. The short-term beneficial effects of steroid injections for symptoms were maintained during the follow-up after 12 months. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53171398. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/19860883/Randomised_controlled_trial_of_local_corticosteroid_injections_for_de_Quervain's_tenosynovitis_in_general_practice_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-10-131 DB - PRIME DP - Unbound Medicine ER -