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In the name of God

This study examines and compares the effectiveness of corticosteroid injection with non-removable fiberglass thumb spica orthosis (TS+CSI) versus corticosteroid injection alone (CSI) in the treatment of de Quervain's tenosynovitis. Results show that TS+CSI is more effective in reducing pain compared to CSI alone.

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In the name of God

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  1. In the name of God

  2. Efficacy of corticosteroid injection with non-removable fiberglass thumb spica orthosis versus corticosteroid injection alone in the treatment of de Quervain’s tenosynovitis Mohsen Mardani-Kivi M.D. Assistant Prof. Orthopaedic Dept. Guilan University of Medical Sciences

  3. Fritz de Quervain A Swiss surgeon First physician In 1895 History

  4. Anatomy

  5. Anatomy The lesion occurs secondary to overuse and repeated activities of wrist in ulnar deviation position while the thumb is in abduction and extension.

  6. Adults Especially women aged 30-50 years Epidemiology

  7. The condition was found to be more TENDINOSISrather than tendinitis due to lack of evidence of any inflammation in the histopathological examinations. Patho-physiology

  8. Diagnosis  clinical • Signs & symptoms: • pain • Tenderness at the first dorsal compartment of the wrist • Positive Finkelstein test Diagnosis

  9. Treatment option • Conventional treatments such as: • rest and reducing daily activities • massage therapy • diathermy • oral analgesics • local steroid injection • biomechanical correction such as: • Orthosis • cast or brace immobilization • strengthening protocols • other modalities such as • cryotherapy • iontophoresis)

  10. Treatment option • Cochrane review of corticosteroid injection for the treatment of de Quervain’s tenosynovitis, demonstrates that methylprednisolone injection relieves the signs and symptoms of the condition faster than other palliative treatments

  11. Treatment option Light Thumb Spica Orthosis (TS) has been reported to have favorable results, with the mechanism of decreasing ulnar deviation and thumb flexion and relieving involved tendons

  12. If conservative treatments fail, surgical methods are recommended that are expensive and invasive Treatment option

  13. Very few studies compare the efficacy of the TS+CSI and CSI (Avci et al., Richie et al., Weiss et al.) Purpose: The present study was conducted to examine and compare the efficacy of TS+ CSI versus CSI alone in the treatment of de Quervain’s tenosynovitis. Purpose *Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J hand surg. 2002;27(2):322-324. *Richie CA, 3rd, Briner WW, Jr. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16(2):102-106. *Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J hand surg. 1994;19(4):595-598.

  14. Methods and Materials:

  15. Methods and Materials:

  16. Methods and Materials:

  17. Demographic data: Total patient population: 67 Both groups were similarwith regards to demographic characteristics, dominant hand, affected hand and occupation status (P>0.05) Both Pre-treatment VAS and Quick-DASH scores was not significantly different between two groups. Results

  18. Results: Demographic Characteristics SD: Standard Deviation,: Chi-square test,¥ : Independent Sample T Test

  19. Results: Primary outcome

  20. In both groups, VAS and Quick-DASH scores were reduced in post-treatment visits (P<0.0001), suggesting that both groups were successful in reducing pain. However CSI+TS was significantly more effective in reducing pain (p<0.0001). The VAS scales were reduced 95.7% in CSI+TS and 79.5% in CSI groups. Results: secondary outcome

  21. Briefly, the repeated measure ANOVA test indicated that the VAS and Quick-DASH scores significantly changed pre and postoperatively in both follow ups. The differences between the two groups were also statistically significant (p<0.0001). In general, the pain relief trend was in favor of the CSI+TS group than CSI group. Results: secondary outcome

  22. Richie et al.: meta-analysis study reviewed all the studies on de Quervain’s tenosynovitis In 2003 reported that CSI, CSI+TS, and Orthosis are successful in 83%, 61%, and 14% of patients respectively . However, the number of reviewed studies was inadequate for a literature review none of the reviewed studies were randomized clinical trial Discussion Richie CA, 3rd, Briner WW, Jr. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. The Journal of the American Board of Family Practice / American Board of Family Practice. Mar-Apr 2003;16(2):102-106.

  23. Peters-Veluthamaningal et al. : Cochrane review study In 2009, databases for relative RCTs Among 563 related titles  only five studies evaluated only one study with eligible criteria. The 18 patients (not randomized, not blinded)  results: the superiority of CSI over TS method. Discussion Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database Syst Rev. 2009(3):CD005616. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. The Journal of hand surgery. Mar 2002;27(2):322-324.

  24. Weiss et al.: prospective study Evaluation of efficacy of the CSI+TS, TS and CSI methods in 93 patients in 1994 treatment success rate: 57, 19 and 67 in CSI+TS, TS and CSI respectively. Conclusion: the CSImethod produced more desired outcomes Discussion: Opposed article Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. The Journal of hand surgery. Jul 1994;19(4):595-598.

  25. In Literature, they argue that it is not possible to judge over efficacy of CSI method over the other methods due to limited number of studies Discussion

  26. The pressure on the wrist and hand, time exposed to pressure and the factors defined as laborious occupation in general may be much more severe in developing countries. Thus, immobilization after CSI may lead to a better therapeutic outcome in such countries. On the other hand the patients in CSI group may not follow all the physician's advices regarding not using the wrist during the recovery period Discussion

  27. Functional outcome in CSI+TS group may increase due to inevitable immobilization of the tendons. reduce the ulnar deviation and thumb flexion rest the involved tendon. • Explanation: the patient is obliged not to move the APL (abductor pollicis longus) and EPB (Extensor Pollicis Brevis) tendons. Discussion

  28. Strengths of our study: • excluding patients with concurrent medical conditions. • both groups similarity with regards to demographic characteristics (age, gender, occupation) • Limitations: • Non-blinding • Lack of Control group Discussion

  29. It seems that corticosteroid injection with thumb spica orthosis has higher treatment success rate and superior functional outcome than corticosteroid injection alone in the treatment of de Quervain’s tenosynovitis. Conclusion

  30. With Regards

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