Efficacy of Local Intralesional Steroid Injection for Pain Relief in De Quervain's Tenosynovitis

Introduction: Conservative treatment options, such as rest, massage, cold and heat packs, wrist splints, braces, physical therapy, thumb spica casts, and local steroid injections, have been used with mixed results to treat De Quervain's tenosynovitis. Surgical treatment, like releasing the first dorsal wrist compartment, is the last resort for resistant cases of De Quervain's tenosynovitis, exhibiting an efficacy of 91%. However, complications and increased expenses have limited the use of surgical interventions.

Objectives: This study aims to determine the efficacy, measured by the reduction in visual analog scale (VAS) scores over a three-week follow-up period, of local intralesional steroid injections in providing pain relief for patients with De Quervain's disease.

Materials and methods: This study is an analytical case series conducted at the Department of Orthopedics, Ghurki Hospital, Lahore, from March 5, 2020, to September 4, 2020. After receiving approval from the ethical review board of Lahore Medical and Dental College, 91 patients who met the inclusion criteria were enrolled in the study. Informed consent was obtained, and demographic details, including age, gender, affected side, place of residence, occupation (student, office worker, or others), and baseline VAS score, were recorded. For injection preparation, 1 mL (10 mg) of triamcinolone acetonide was mixed with 1 mL (1%) of lidocaine hydrochloride in a 5-cc syringe. The corticosteroid injection was administered using a 24- or 26-gauge needle. Before injection, the area of maximum tenderness was confirmed. The needle was then inserted into the first extensor compartment of the wrist, directed proximally toward the radial styloid process, and aligned parallel to the abductor pollicis longus and extensor pollicis brevis tendons. Swelling of the synovial sheath due to the volume effect was observed. Post-injection, patients were allowed NSAID (nonsteroidal anti-inflammatory drug) tablets for pain relief as needed. The principal researcher administered all injections. Each patient was followed up for three weeks, and efficacy, as defined in the operational criteria, was recorded.

Results: The participants in the study ranged from 25 to 65 years of age, with a mean age of 41.40 ± 10.62 years. The majority of the patients were aged between 25 and 45 years, comprising 60 patients (65.93%). Out of the 91 patients, 56 (61.54%) were male, and 35 (38.46%) were female, resulting in a male-to-female ratio of 1.6:1. In our study, efficacy (in terms of pain relief) of local intralesional steroid injection in De Quervain's disease was seen in 79 (86.81%) patients.

Conclusion: This study demonstrates that local intralesional steroid injections are effective in providing pain relief for De Quervain's tenosynovitis in a Pakistani cohort. This finding aligns with efficacy results from international studies and supports its use as a primary treatment option in diverse populations.