gms | German Medical Science

Objectives/Interrogation: In de Quervain's disease (dQD), it has been described in many previous studies that failure to inject of steroid into the first compartment could result in persistent symptom. Therefore, recent studies have been focused on ultrasound (US) guided accurate intra-synovial injection into the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons for enabling the steroid to reach both tendon sheath in patients with complete septation. We hypothesize that accurate injection of steroid into an EPB compartment alone is as effective as injection into both compartments in dQD.

Methods: A prospective, randomized controlled study was performed at a single center between 2017 and 2018 using patient who presented with dQD. The patients were divided into two groups: Group 1, in which we injected into the compartments of APL and EPB tendon, respectively and Group 2, in which we injected only into the EPB compartments. All injections were performed by single orthopedic surgeon under US-guided. Pain and functional outcome was assessed by visual analogue score (VAS), quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores and subjective response of patients.

Results and Conclusions: A total of 27 US-guided injections have been performed in 27 patients after clinical and ultrasound examination. 14 patients were classified into group 1 and 13 patients were into group 2. Pain on the 100 mm VAS for the group 1 was 82.8 and group 2 was 72.7 at baseline. At 2 weeks after steroid injection, pain and clinical scores improved in both groups. However, there was no significant differences in pain and clinical scores at 2, 6 weeks and final follow-up. Furthermore, no significant differences were seen in subjective response and the ratio of surgeries/total in each group.

In conclusion, Our findings suggest US-guided injection targeting the EPB alone is as effective as targeting both compartments in dQD patients with complete septation.