Safety, Efficacy and Recurrence rate following tenosynovectomy and intralesional steroid

Abstract

Background: deQuervain\'s disease may be treated conservatively or surgically. Restricting operation to those in whom conservative treatment failed tends to prolong treatment. Objective: This study was conducted to compare the safety, efficacy and recurrence rate of primary tenosynovectomy versus intralesional steroid injection in the treatment of sclerosing tenosynovitis of deQuervain. Method: A prospective, comparative study of the safety, efficacy and recurrence rate following intralesional steroid and tenosynovectomy in the treatment of deQuervain\'s disease was done. The patients were assigned to the study groups (tenosynovectomy-Group A and injection methylprednisolonegroup B). Analysis of outcome was performed post-operatively and the results were assessed for statistical significance. Results: Fifty patients, sixteen males and thirty-four females, had their data evaluated. The dominant hand was involved in sclerosing tenosynovitis of deQuervains in 49 out of 55 thumbs. In Five patients there was bilateral involvement. Intralesional injection was about six times faster to carry-out than tenosynovectomy. There was immediate relief from pain in all the patients who had tenosynovectomy and intralesional steroid/Lignocaine injection. One patient had numbness in group A while eight patients had hypopigmentation at the site of injection in group B. The tenosynovectomy incisions healed without infection or unsightly scarring. Conclusions: The safety and efficacy of tenosynovectomy is not statistically superior to steroid injection in the treatment of deQuervain\'s disease. However, tenosynovectomy is superior to intralesional steroid injection in terms of recurrence rate. Keywords: deQuervains disease, tenosynovectomy, intralesional steroid, recurrence.Nigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 17-19