Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice.
BACKGROUND
De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed.


METHODS
Participants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections) were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA) or 1 ml of NaCl 0.9% (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF).


RESULTS
11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015), perceived improvement (78% vs. 33%; p = 0.047) and severity of pain (4.27 vs. 1.33; p = 0.031) but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112). Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76) with a number needed to treat of 2 (95% CI: 1, 3). In the cohort of steroid responders (n = 12) the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67) and scores of Dutch AIMS-2-HFF (p = 0.36), but not for patient perceived improvement (p = 0.02). No adverse events were observed during the 12 months of follow-up.


CONCLUSIONS
One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. The short-term beneficial effects of steroid injections for symptoms were maintained during the follow-up after 12 months.


BACKGROUND
Current Controlled Trials ISRCTN53171398.
Peters-Veluthamaningal
Cyriac
C
Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands. raju@dds.nl
Winters
Jan C
JC
Groenier
Klaas H
KH
Meyboom-DeJong
Betty
B
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D053684:De Quervain Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004185:Disability Evaluation; D005194:Family Practice; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D014955:Wrist Joint / Q000503:physiopathology*
D000305:Adrenal Cortex Hormones; D014222:Triamcinolone Acetonide