A Prospective Study to Compare the Effect of Ultrasonography Guided versus Anatomical Landmark-based Triamcinolone Injection in the Treatment of De Quervain's Tenosynovitis

Abstract

Introduction: De Quervain's tenosynovitis (DQT) is a stenosing tenosynovitis of the first extensor compartment of the wrist affecting abductor pollicis longus and extensor pollicis brevis tendons, leading to the narrowing of the fibro-osseous canal, causing radial side wrist pain, decreased thumb and wrist movement culminating in functional impairment of hand. The treatment options for DQT include conservative, minimally invasive procedures and surgery. Minimally invasive procedure, like intra-sheath corticosteroid (CST) injections is a preferred treatment option and ultrasonography (USG) guidance has improved injection accuracy. Role of USG guidance is not yet fully proven in showing clinical improvement and decreasing steroid-associated injection site skin hypopig-mentation. This study aimed to evaluate the role of USG in the clinical improvement and reducing chances of steroid-associated skin hypopigmentation following USG-guided intra-sheath CST injections in comparison to anatomical landmark-based (ALB) technique, in the first extensor compartment of the wrist in DQT. Methodology: A single blind prospective study was done on 83 patients of DQT. Patients were randomized into ultrasonography guided group and anatomical landmark based group according to the injection technique used. A single dose of 1 ml Triamcinolone (40 mg/ml) and 1 ml of 2% Lignocaine was used for injection and patients were followed after 4 weeks and 12 weeks of injection. The visual analog scale (VAS) for pain, patient-rated wrist evaluation (PRWE) score, symptom improvement rate, recurrence rate, steroid-associated injection site skin hypo-pigmentation, and delayed injection site skin hypopigmentation were used for outcome measures. Results: After 4 and 12 weeks, VAS and PRWE scores significantly improved in both groups (p value0.05). The symptom improvement rate at 12 weeks (81.58% in USG versus 57.5% in ALB) was..

Keywords

• Corticosteroid injection, De Quervain's teno-synovitis, First extensor compartment, Triamcinolone, Ultrasonography, VAS.