To compare the effectiveness of Ultrasound-guided infiltration of steroids vs surgical release in de Quervains tenosynovitis

Introduction: de Quervain’s tenosynovitis is a stenosing tenosynovitis of the first extensor compartment of the wrist and leads to wrist pain along with impaired function of the wrist and hand. Local steroid injection and surgical release forms the mainstay treatment in the conservative and surgical line of treatment respectively till date. This study aims to bring out the effectiveness of local steroid injection given accurately under ultrasound guidance making it comparable to surgical release in the short term period , thereby emerging as an immediate and cost – effective line of management.

MATERIAL & METHODS: Twenty three patients diagnosed with de Quervain’s tenosynovitis were included in this study whom did not show any relief of symptoms when conservative mode was used namely rest and analgesics and splinting in certain cases. Clinically patients were assessed using DASH score based on the severity of condition before the procedure and after the procedure. A mixture of 1 ml of triamciniolone and 1 ml of 1% lidocaine hydrochloride was taken under aseptic precautions and was injected into the involved compartment under expert guidance with help of ultrasound imaging. Clinical improvement was later evaluated by analyzing the pre procedural and post procedural DASH (Disabilities of the Arm, the Shoulder and the Hand) score indexes comparing it to surgical release.8

RESULTS: 22 patients (96% were symptom-free) out of the 23 patients that were included, after the 1st injection at two weeks. At the end 6 months 22 (96%) patients were symptom free and were fully satisfied with the gratifying outcome. No recurrence in these patients after a 1 year of follow-up was recorded.

The one failed patient underwent surgery for release of the first extensor compartment and was symptom-free at the 2 weeks post –op after assessment. Adverse reaction of the steroids were incidentally seen in 2/23 (16%) of the patients, which eventually subsided in 20 weeks. Incidence of nerve injury, infection, or tendon rupture did not occur.

CONCLUSION: We draw to close that selective infiltration of steroids in the common sheath of the EPB and APL under Ultrasound -guidance provides an evocative improvement of pain and function in greater number of patients with de Quervain’s Syndrome thereby avoiding a possible surgery.

Keyword: Ultrasound guided, infiltration, DASH