Comparison of Corticosteroid Injection (CSI) With Or Without Thumb Spica Cast (TSC) For De Quervain Tendinitis

Abstract

Background: De Quervain’s disease or stenosing tenosynovitis of the first dorsal compartment of the wrist is a common condition, which affects the Abductor pollicislongus and the extensor pollicis brevis tendons. There are characteristic signs and symptoms including a positive Finkelstein's test.Aim: To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis.Material and methods: Thestudywasconducted in the Department of orthopaedic, Madhubani Medical College and Hospital, Madhubani,Bihar, India fromAugust 2019 to January 2020. Total 200 patients with de Quervain tenosynovitis and pain on the radial side of the wrist, tenderness at the first dorsal compartment, a positive Finkelstein test, and a pain score greater than 6 were include in this study. The patients were assigned to either TSC + CSI or CSI groups using a random block sequence. All patients in CSI + TSC and CSI groups received 40 mg of methylprednisolone acetate (1 cc) with 1 cc lidocaine 2% by M.M.-K. Using an insulin needle (25 or 27 gauge) in the first dorsal compartment at the point of maximal tenderness. The patients in the CSI + TSC group received a fiberglass TSC as well.Results:The reduction rates in CSI + TSC and CSI were 94% and 81%, respectively. The repeated measure analysis of variance test indicated that the reduction rate of VAS and QuickDASH scores were statistically significant in both groups. The differences between the 2 groups were also statistically significant (P<.001). In general, the pain relief trend was in favor of the CSI + TSC group rather than the CSI group.Conclusions: The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes.

Keywords:de Quervain tenosynovitis, corticosteroid injection, thumb spica casting.