Speakers Bureau: Trimed (Chadderdon), Auxillium (Gaston), Biomet (Gaston), BME (Gaston) Royalty: Biomet (Gaston) Consulting Fee: Biomet, BME (Gaston) Other: ASSH Committee member, JHS Editorial Board (Gaston) While the mechanism of action is unclear, injectable corticosteroids, primarily betamethasone, are a well-accepted treatment of De Quervain’s tenosynovitis, but are contraindicated for diabetics with elevated blood glucose. If steroids are effective for De Quervain’s because of their anti-inflammatory properties, then there is a reasonable argument for local injection of toradol, a non-steroidal anti-inflammatory drug (NSAID), which is efficacious in shoulder pathology1 and not contraindicated in diabetics. Following informed consent, patients diagnosed with De Quervain’s tenosynovitis were randomized to an injection of corticosteroid (betamethasone) or NSAID (ketorolac). The investigator and patient were blinded to randomization. The primary study outcome was pain with Finkelstein test at 6 weeks post-injection. Patients whose symptoms were not improved at 6 weeks were offered an injection of betamethasone as standard-of-care, regardless of initial randomization. Secondary outcome measures included pain with palpation of the first dorsal compartment tendons and patient-reported outcomes (Veterans RAND 12 Item Health Survey [VR-12] and Disabilities of the Arm, Shoulder, and Hand [DASH] scores). To date, 30 patients (mean age: 55.2 years) with six-week follow-up have been randomized to betamethasone (n = 13; 43%) or ketorolac (n = 17; 57%) injection. While there was no significant difference in pain at baseline with Finkelstein test (P = 0.194) and palpation (P = 0.802), patients in the betamethasone group had significantly lower pain at 6 weeks with the Finkelstein test (22/100 vs. 46/100; P = 0.031) and palpation (15/100 vs. 52/100; P = 0.002). Over half of patients in the ketorolac group required an additional injection at six-weeks, compared to less than one-quarter in the betamethasone group (9/17 = 52.9% vs. 3/13 = 23.1%; P = 0.098). While there was no significant difference in the VR-12 between groups at six weeks, DASH disability/symptom (8.5 vs. 35.6; P = 0.001) and work (9.4 vs. 33.2; P = 0.0210) scores were significantly better in the betamethasone group. •Patients randomized to betamethasone injection had significantly lower pain scores and better patient-recorded outcomes at six weeks compared to patients randomized to ketorolac injection.•While not statistically significant, patients randomized to the ketorolac group (9/17) were more likely to require a second injection compared to patients randomized to betamethasone (3/13).•Preliminary results indicate that betamethasone is a superior treatment for DeQuervains tenosyovitis, which suggests that the mechanism of action of betamethasone may not be its anti-inflammatory action.