Ultrasound-guided intervention and hand tenosynovitis in patients with diabetes mellitus

Abstract

Background: Flexor tenosynovitis is a frequent cause of hand pain in diabetic patients, and corticosteroid (CS) injection is usually efficiently used in the treatment protocol. Ultrasound (US) guidance is usually helpful for accurate needle placement and improves the outcome. Aim of the Work: The aim of the work was to evaluate the efficacy of US-guided injections compared to clinically guided injections, the treatment of flexor tenosynovitis in diabetic hands. Patients and Methods: Patients were divided into two matched groups of diabetic patients with flexor tenosynovitis: Group 1 – treated with local CS injection under US guidance and Group 2: treated with local CS injection under clinical guidance. Both the groups were assessed twice for pain and tenderness using visual analog scale (VAS) and Richie index, respectively, one before the injection and the second 1 month after. All affected tendons were assessed and graded by US and power Doppler at baseline and 1 month after the injection. Results: Both the groups were matched as regards the disease duration, age, and glycated hemoglobin A1c. The mean VAS for Group 1 was 8.1 ± 0.8 cm at baseline and 3.4 ± 0.7 cm in the second visit; greyscale US showed improvement in 16 patients (61%). The mean VAS was 8.3 ± 0.7 cm at visit one, while it dropped down to 4.5 ± 0.9 cm in visit two. Conclusion: US-guided injections of CSs are statistically superior to clinically guided in treating flexor tenosynovitis in diabetic patients.