Local Steroid Injection Versus Surgical Release for Treatment of Persistent De Quervain's Stenosing Tenosynovitis (DQST)

A Prospective Comparative Study

Ibrahim Mazrou, MBBCH; Mohamed Ramadan, MD; Ashraf Atef, MD; Ahmed El Elemy, MD

Disclosures

Curr Orthop Pract. 2022;33(1):27-31. 

In This Article

Discussion

DQST is handicapping. Many studies reported that it is common in women and has a peak prevalence among those in their forties, especially in pregnant women and nursing mothers.[4] Many studies reported that the dominant hand was more affected, and bilateral involvement was often reported in new mothers or childcare providers.[4,12]

The results for group A agree with a study done by Pooswamy and Muralidharaogpalan,[12] who reported a high success rate with intrasheath corticosteroid injections. Results also agreed with Rowland et al.,[13] who concluded that corticosteroid injection resulted in symptom resolution, pain relief, and increased hand function in patients with DQST. Results also agreed with those reported by Rankin,[14] who stated that most cases of DQST could be treated with a combination of lidocaine and steroid injection, which could achieve pain relief for the patient and give physicians the option to delay surgery until it was indicated. A study done by Tiwari and Sharma[15] concluded that longitudinal injection is more precise than vertical injection, accurate injection of the needle into the tendon sheath is very important to have the full effect. This agrees with the present study's method of injection and injection results.

The results in group B of the present study agree with Morshed et al.[7] and Lee et al.[16] who reported significant improvement of pain and hand function after surgical release in DQST. However, a study done by Kay[17] reported a 90% failure rate in surgical release, which disagreed with the present study's results and with results of most other authors and could have been caused by difference in patient selection parameters. Results also disagreed with Acar and Memik,[18] who suggested that open surgery is more useful than steroid injection with relatively low recurrence; the results of the current study showed no significant difference between the two methods.

The highest percentage of favorable results was up to the age of 35 yr in both groups, and this agreed with Johnson,[5] who reported that it affected women in child-bearing age, and with Tiwari and Sharma,[15] who reported that it affects mainly middle-aged patients. Results were comparable with the results of Pooswamy and Muralidharaogpalan[12] and Sawaizumi et al.,[19] who reported the occurrence of disease mainly in patients in their middle forties. The vast majority in the present study were female patients (90%), and dominant hands were affected in 18 patients (60%). This agreed with the study by Pooswamy and Muralidharaogpalan,[12] Rankin,[14] Lee et al.,[16] and Acar and Memik,[18] who reported that women were at higher risk than men. However, the results of the current study disagreed with the results of Faithfull and Lamb,[20] who found no relation between hand dominance and occurrence of DQST.

Of the married women, there were 11 lactating (44%) and 14 nonlactating female patients (56%). These results were comparable to a study done by Johnson,[5] who reported six patients with DQST in the postpartum period; three of them were lactating, and their symptoms improved by the end of breastfeeding. This high incidence in lactating females also agreed with Keon-Cohen,[21] who postulated that DQST in postpartum women may be caused by the position of the thumb in abduction for extended periods while holding the baby during lactation and newborn hygiene.

Twenty-three patients (76.7%) were housewives, which agreed with Morshed et al.,[7] who reported that most patients were housewives or workers whose occupations require repetitive movements and powerful handgrip.

Comparing the present study results with Pooswamy and Muralidharaogpalan's results,[12] 40.6% of patients developed complications after injection therapy in the form of recurrence, depigmentation, and immediate pain, but most of these complications resolved by the end of follow-up. Sawaizumi et al.[19] also reported complications in 27.9% of the injected hands in the form of temporary pain aggravation that disappeared in 2 wk, skin depigmentation, and subcutaneous fat atrophy. These complications disappeared spontaneously in all hands within 6 mo. Morshed et al.[7] reported three complications (10.3%) from surgical release in the form of superficial infection in one patient, which was cured with antibiotics, and tendon subluxation in two patients. Lee et al.[16] also reported only one complication (3%) of surgical release in the form of persistent complaints. However, the patient had decreased severity and normal function.

Limitations and Future Perspectives

The limitations of the present study were the small number of patients and restriction to one medical facility. The authors expect future studies to include multiple medical center experiences, which will compare different methods of injection and different surgical approaches, evaluate the correlation between DQST and radiographic parameters of the wrist, and study the effect of DQST on range of motion.

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