The Relationship between Physical Findings and the Recurrence after Steroid Injection in De Quervain's Disease

Byung Hak Oh; Youn Moo Heo; Jin Woong Yi; Jae Ik Lee; Jae Sin Lee

doi:10.12790/jkssh.2016.21.3.131

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Oh, Heo, Yi, Lee, and Lee: The Relationship between Physical Findings and the Recurrence after Steroid Injection in De Quervain's Disease

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(3):131-136.

Published online: 11 September 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.3.131

The Relationship between Physical Findings and the Recurrence after Steroid Injection in De Quervain's Disease

Byung Hak Oh, Youn Moo Heo, Jin Woong Yi, Jae Ik Lee, Jae Sin Lee

Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea

Correspondence to: Youn Moo Heo, Department of Orthopedic Surgery, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea, TEL: +82-42-600-9120, 6937, FAX: +82-42-545-2373, E-mail: hurym1973@hanmail.net

Received 26 May 20168 August 2016 Accepted 8 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to evaluate the effect of steroid injection according to the stage of Finkelstein's test and the severity of tenderness on radial styloid in de Quervain's disease.

Methods:

Between January 2011 and December 2012, a total of 57 patients (57 wrists) treated with steroid injection in de Quervain's disease were enrolled on this study. The severity of tenderness, the stage of Finkelstein's test and pain score using visual analogue scale (VAS) were assessed before steroid injection. And the effect of steroid injection was assessed until one year after steroid injection. The relationship between the recurrence of de Quervain's disease after steroid injection and pre-injection findings including tenderness, Finkelstein's test and VAS was assessed.

Results:

The success rate of steroid injection was 71.9% (41/57 patients). The outcome of steroid injection was not significantly related to the severity of tenderness (p=0.648), the stage of Finkelstein's test (p=0.530) and VAS score (p=0.607).

Conclusion:

The tenderness on radial styloid and the Finkelstein's test are important physical findings for the diagnosis of de Quervain's disease. However, the severity of tenderness and the stage of Finkelstein's test were not showed as predictive factors for the outcome.

Keywords: De Quervain's disease, Finkelstein's test, Steroid injection

REFERENCES

1. Finkelstein H. Stenosing tendonvaginitis at the radial styloid process. J Bone Joint Surg Am. 1930; 12:509–40.

2. Ilyas AM. Nonsurgical treatment for de Quervain's tenosynovitis. J Hand Surg Am. 2009; 34:928–9.

3. Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg Am. 1998; 23:89–96.

4. Mirzanli C, Ozturk K, Esenyel CZ, Ayanoglu S, Imren Y, Aliustaoglu S. Accuracy of intrasheath injection techniques for de Quervain's disease: a cadaveric study. J Hand Surg Eur Vol. 2012; 37:155–60.

5. Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S. Treatment of de Quervain disease with triamcinolone injection with or without nimesulide: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004; 86:2700–6.

6. Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, Hashemi-Motlagh K, Safieb-Ekfitiari K, Akhoondzadeh N. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis. J Hand Surg Am. 2014; 39:37–41.

7. Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991; 73:219–22.

8. Dawson C, Mudgal CS. Staged description of the Finkelstein test. J Hand Surg Am. 2010; 35:1513–5.

9. McAuliffe JA. Tendon disorders of the hand and wrist. J Hand Surg Am. 2010; 35:846–53.

10. Lok RL, Griffith JF, Ng AW, Wong CW. Imaging of radial wrist pain. Part II: pathology. Skeletal Radiol. 2014; 43:725–43.

11. Elliott BG. Finkelstein's test: a descriptive error that can produce a false positive. J Hand Surg Br. 1992; 17:481–2.

12. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007; 31:265–8.

13. McKenzie JM. Conservative treatment of de Quervain's disease. Br Med J. 1972; 4:659–60.

14. Leao L. De Quervain's disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958; 40:1063–70.

15. Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am. 1986; 68:923–6.

16. Kume K, Amano K, Yamada S, Amano K, Kuwaba N, Ohta H. In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. J Hand Surg Eur Vol. 2012; 37:523–7.

17. McDermott JD, Ilyas AM, Nazarian LN, Leinberry CF. Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res. 2012; 470:1925–31.

18. Loomis LK. Variations of stenosing tenosynovitis at the radial styloid process. J Bone Joint Surg Am. 1951; 33:340–6.

Table 1.

Summary of patients

	Successful outcome	Recurred symptom	Total	p-value
Patients (no.)	41	16	57	-
Average age (yr)	49.1	52.6	50.1 (23-78)	0.529
Sex (male:female)	12:29	5:11	17:40	0.545
Dominant hand (right:left)	35:6	14:2	49:8	0.723
Symptom duration (mo)	2.88 (1-12)	2.63 (1-8)	2.81 (1-12)	0.926
Occupation				0.120
Forceful	30	12	42
Less demanding	9	3	12
Unemployed	2	1	3
VAS before steroid injection (point)	5.73 (5-7)	5.94 (5-7)	5.79 (5-7)	0.607
Initial tenderness severity (point)	1.76	1.81	1.77	0.648

VAS, visual analogue scale.

Table 2.

The distribution of results according to visual analogue scale (VAS) score before steroid Injection

VAS (point)	Steroid injection
VAS (point)	Success	Failure or recurrence	Total
0-4 (not included)	-	-	-
5	16	4	20
6	19	9	28
7	6	3	9
8-10	0	0	0
Total	41	16	57

VAS, visual analogue scale.

Table 3.

The correlation between initial tenderness severity and the results of steroid injection

Tenderness severity (point)	Steroid injection			p-value
Tenderness severity (point)	Success	Failure or recurrence	Total	p-value
No pain (0)	0	0	0
Tolerable pain (1)	9	3	13
Abrupt reaction (2)	32	13	44
Total	41	16	57	0.648

Table 4.

The correlation between the stage of Finkelstein test and the results of steroid injection

Finkelstein test	Steroid injection			p-value
Finkelstein test	Success	Failure or recurrence	Total	p-value
Stage I	3	0	3
Stage II	20	8	28
Stage III	18	8	26
Total	41	16	57	0.530

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