EFFECTIVENESS OF COMBINED CORTICOSTEROID INJECTION AND THUMB SPICA CAST VERSUS CORTICOSTEROID INJECTION ALONE IN MANAGING DE QUERVAIN'S TENOSYNOVITIS

Abstract

Introduction: The combined use of corticosteroid injections and thumb spica casts represents a promising therapeutic approach for managing De Quervain's tenosynovitis, aiming to enhance pain relief and functional recovery.

Objectives: To determine the effectiveness of combined corticosteroid injection and thumb spica cast versus corticosteroid injection alone in managing de quervain's tenosynovitis

Materials & Methods: A total of 150 patients diagnosed with De Quervain's tenosynovitis were enrolled from the outpatient orthopedic clinics of Shaikh Zayed Hospital, Lahore over a 12-month period Jan 2023 to Jan 2024. Inclusion criteria were adults aged 18 to 65 years with a clinical diagnosis of De Quervain's tenosynovitis confirmed by a positive Finkelstein test and tenderness over the first dorsal compartment. Participants were randomly assigned to one of two treatment groups using a computer-generated randomization sequence. Group A (n=75) received a single corticosteroid injection (40 mg of triamcinolone acetonide) into the first dorsal compartment. Group B (n=75) received the same corticosteroid injection followed by immobilization with a thumb spica cast for a period of four weeks. Baseline assessments included demographic data (age, gender, occupation), duration of symptoms, and baseline pain and functional status measured using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Statistical analysis was performed using SPSS software version 25.0..

Results: The recurrence rate of symptoms was notably lower in the combined treatment group (6.7%) compared to the corticosteroid injection alone group (20.0%), and this difference was statistically significant (p = 0.014), indicating that the combined treatment may be more effective in preventing symptom recurrence. Patient satisfaction was significantly higher in the group that received the thumb spica cast along with corticosteroid injection, as evidenced by a higher average satisfaction score on the Likert scale (4.5 compared to 3.8, p < 0.001). Adverse events were reported more frequently in the combined treatment group, though the difference was not statistically significant (p = 0.385), suggesting that the addition of the thumb spica cast does not significantly increase the risk of adverse outcomes relative to corticosteroid injection alone.

Conclusion: In conclusion, our study supports the use of a combined treatment approach involving corticosteroid injection and thumb spica cast for De Quervain's tenosynovitis, showing superior outcomes in terms of pain relief, functional improvement, and patient satisfaction compared to corticosteroid injection alone.