Comparative Study between Intralesional Steroid Injection and Thumb Spica Splint in the Treatment of De Quervain’s Disease

Abstract

Background: De Quervain's disease (DQ) is painful tenosynovitis involving APL & EPB tendons caused by overuse or repetitive activity. Various modalities of treatment of DQ in western population including local corticosteroid injection, splinting or both. However, there is no data regarding the efficacy of these two modalities in Bangladesh. Therefore, the purpose of the study is to compare the effects of intralesional corticosteroid injection and thumb spica splint in the management of De Quervain's disease in this population. Methods: This randomized clinical trial was conducted with 60 adult patients either male or female diagnosed as a case of De Quervain's disease (moderate to severe pain) attending outpatient department of Physical Medicine and Rehabilitation in DMCH forsix month’s period. The patients were randomly assigned into two groups by lottery, i.e. Group-A: Intralesional methyl prednisolone acetate 0.5 ml (20mg) + 0.5 ml of 2%lidocaine, Group-B: Thumb Spica Splint. Intralesional corticosteroid injections were given with 1cc syringe between the synovial sheath and the tendons, during the initial visit. Group-B patients were advised to use Thumb Spica splint continuously. The patients of both groups were advised to follow the ADL instructions for the affected hand as much as possible. Outcome was measured by Visual Analogue Scale (VAS) and Patient Rated Wrist Evaluation (PRWE) scale. Every patient was assessed every week for 6 weeks. The level of significance was assessed with the help of paired t-test and chi-square test where necessary.Results: Among the 60 patients (30 in each group), highest numbers of patients were found to be in 41-45 year-age group (35%) followed by 28.33% in 46-50 years group with mean age of 41.77±5.43 years. Male-to-female ratio was 1:7.6. More than half of the patients (53%) had been suffering from the disease in their right hand, 42% in left hand and 5% in both hands. There was no significant difference in pretreatment VAS &PRWE scores between two groups. They show significant mean changes in each of the three follow ups between the two groups of patients (p=<0.001). Intralesional methylprednisolone acetate injection provided pain relief in 83.33% of patients compared to 36.67% in splint group. Conclusion: Intralesional steroids are more effective to relief pain & discomfort than thumb Spica splint in management of moderate to severe De Quervain's disease.