Abstract and Introduction
Abstract
Background: De Quervain's stenosing tenosynovitis (DQST) can prevent patients from performing minor tasks as opening jars and texting. It is common in pregnant women and nursing mothers. The etiology is thought to be from repetitive manual work with thumb abduction and wrist ulnar deviation. The aim of this study was to compare steroid injection versus surgical release results for treatment of persistent DQST.
Methods: Thirty-one hands of 30 patients with DQST who fulfilled the study selection criteria and treated during 2020 were included in this prospective study after institutional ethics committee approval. Patients were grouped into the mini-injection (group A) or surgical category (group B). Retrograde injection parallel to the tendons was used for injection. Transverse skin incision followed by longitudinal dissection and incision of the extensor retinaculum was used for surgical release. Clinical assessment of patients was done using a functional De Quervain's score modified after the Disabilities of the Arm, Shoulder and Hand Score and Michigan Hand Outcome Questionnaire.
Results: At the final follow-up, 13 out of 16 hands in group A improved. The mean score was 14±12.38, with nine, four, one, and two hands having excellent, good, fair, and absolute disability results, respectively. All 15 hands of group B improved. The mean score was 9.87±5.17, with nine, five, and one hands having excellent, good, and fair results, respectively.
Conclusions: Both corticosteroid injection and surgical release were effective in persistent DQST treatment with insignificant differences, therefore the less invasive injection would be preferred.
Level of Evidence: Level II.
Introduction
The extensor tendons run across the dorsum of the wrist and are held in position by the extensor retinaculum. Fibrous bands extend from the deep surface of the retinaculum and attach to the radius and ulna, resulting in six separate fibro-osseous compartments.[1] De Quervain's stenosing tenosynovitis (DQST) affects the first dorsal compartment of the wrist and occurs because of the relative insufficiency between abductor pollicis longus (APL), extensor pollicis brevis (EPB) and their tunnels.[2] Its overall incidence is 0.9 per 1,000 person-years, which represents a serious health problem.[3] The highest age prevalence is between 30 and 50 yr with peak prevalence among those in their forties. Bilateral involvement is often reported in new mothers or childcare providers.[4] This disease has higher incidence among nursing mothers and pregnant women, especially at their last trimester. Patients may continue to have symptoms even after delivery or cessation of breastfeeding.[5,6]
The etiology and pathology of this condition is not clear but it is thought to be caused by repetitive and forceful manual work with the wrist ulnar-deviated and thumb-abducted and extended, which causes microtears and could lead to collagen disorientation, myxoid degeneration, accumulation of mucopolysaccharides, and thickening of the extensor retinaculum.[7] Understanding the anatomy of the anatomical snuff box and its contents is very important to avoid injury of important structures such as the radial artery or its variant aberrant radial artery, the superficial branch of the radial nerve, and the cephalic vein if any procedure is planned near that region.[8–10]
Many treatment options are available for this condition including nonsurgical options that include rest, splinting, nonsteroidal antiinflammatory drugs, icing the affected area, physical therapy, and local corticosteroid injection or surgical release of the first dorsal compartment.[2,11]
In this study, we aimed to compare results of local corticosteroid injection versus surgical release for treatment of persistent DQST and detect the superiority of one treatment method over the other. The authors hypothesized that the injection method would be superior to surgical release.
Curr Orthop Pract. 2022;33(1):27-31. © 2022 Lippincott Williams & Wilkins
