Local steroid injection versus surgical release for treatment of persistent De Quervain’s stenosing tenosynovitis (DQST): a prospective comparative study

Abstract

Background: De Quervain’s stenosing tenosynovitis (DQST) can prevent patients from performing minor tasks as opening jars and texting. It is common in pregnant women and nursing mothers. The etiology is thought to be from repetitive manual work with thumb abduction and wrist ulnar deviation. The aim of this study was to compare steroid injection versus surgical release results for treatment of persistent DQST. Methods: Thirty-one hands of 30 patients with DQST who fulfilled the study selection criteria and treated during 2020 were included in this prospective study after institutional ethics committee approval. Patients were grouped into the mini-injection (group A) or surgical category (group B). Retrograde injection parallel to the tendons was used for injection. Transverse skin incision followed by longitudinal dissection and incision of the extensor retinaculum was used for surgical release. Clinical assessment of patients was done using a functional De Quervain’s score modified after the Disabilities of the Arm, Shoulder and Hand Score and Michigan Hand Outcome Questionnaire. Results: At the final follow-up, 13 out of 16 hands in group A improved. The mean score was 14±12.38, with nine, four, one, and two hands having excellent, good, fair, and absolute disability results, respectively. All 15 hands of group B improved. The mean score was 9.87±5.17, with nine, five, and one hands having excellent, good, and fair results, respectively. Conclusions: Both corticosteroid injection and surgical release were effective in persistent DQST treatment with insignificant differences, therefore the less invasive injection would be preferred. Level of Evidence: Level II.