title: Ultrasound-guided percutaneous injection to treat de Quervain's disease using three different techniques: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the six-month outcome of three different ultrasound-guided treatments for de Quervain's disease (DQD).
  
  
  METHODS
  We prospectively treated 75 consecutive patients (51 females, 24 males, mean age ± standard deviation = 45.3 ± 9.8 years) with DQD. Patients' features (hand dominance, intraretinaculum septum, accessory tendons) were recorded. Visual analogue scale (VAS), reduced disability (quickDASH) score, and retinaculum thickness were evaluated at baseline and after one (excluding retinaculum thickness), three, and six months. Patients were randomized into three groups of 25 patients each treated under ultrasound guidance: Group A (1 ml methylprednisolone acetate; mean baseline thickness = 1.6 mm; mean baseline VAS = 6; mean baseline quickDASH = 55); Group B (1 ml methylprednisolone acetate +15-day delayed 2 ml saline 0.9 %; 1.4; 6; 56); Group C (1 ml methylprednisolone acetate +15-day delayed 2 ml low molecular weight hyaluronic acid; 1.7; 6; 55).
  
  
  RESULTS
  After one month results were: Group A mean VAS = 2; mean quickDASH = 23; Group B 2; 22; Group C 2; 21. After three months results were: Group A retinaculum thickness = 0.7 mm; 3; 27); Group B 0.8 mm; 1; 25; Group C 0.5 mm; 1; 23. After six months results were: Group A 1.5 mm; 3; 51; Group B 1 mm; 2; 51; Group C 0.7 mm; 1; 26 (P < 0.001 for all vs. baseline). Patients' age, sex, hand dominance, presence of subcompartment dividing septum, and supernumerary tendons had no influence on outcome (P  ≥  0.177).
  
  
  CONCLUSIONS
  Addition of hyaluronic acid to ultrasound-guided injections of steroids to treat DQD seems to improve the outcome and to reduce the recurrence rate.
  
  
  CONCLUSIONS
  • Ultrasound guidance allows for safe injection procedures to treat de Quervains' disease • Steroid injections allow prompt recovery in de Quervain's disease with short-term recurrence • Addition of hyaluronic acid allows recurrence rate reduction compared to simple steroid injections.
authors.affiliation: Department of Radiology, Genoa University, Via L.B. Alberti 4, 16100, Genova, Italy, theabo@libero.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Orlandi
authors.forename: Angelo
authors.initials: A
authors.lastname: Corazza
authors.forename: Emanuele
authors.initials: E
authors.lastname: Fabbro
authors.forename: Giulio
authors.initials: G
authors.lastname: Ferrero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sabino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.forename: Enzo
authors.initials: E
authors.lastname: Silvestri
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D053684:De Quervain Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D015552:Injections, Intralesional; D007279:Injections, Subcutaneous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055675:Viscosupplements / Q000008:administration & dosage / Q000627:therapeutic use; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D000893:Anti-Inflammatory Agents; D055675:Viscosupplements; D000077555:Methylprednisolone Acetate; D012965:Sodium Chloride; D006820:Hyaluronic Acid; D008775:Methylprednisolone