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Ultrasound-guided percutaneous injection to treat de Quervain’s disease using three different techniques: a randomized controlled trial

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

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).

Conclusion

Addition of hyaluronic acid to ultrasound-guided injections of steroids to treat DQD seems to improve the outcome and to reduce the recurrence rate.

Key Points

• 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

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Acknowledgments

The scientific guarantor of this publication is Dr. Enzo Silvestri. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Young Researchers Grant awarded by the European Society of Musculoskeletal Radiology. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, randomised, controlled, multicentrr study.

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Authors and Affiliations

  1. Department of Radiology, Genoa University, Via L.B. Alberti 4, 16100, Genova, Italy

    Davide Orlandi, Angelo Corazza, Emanuele Fabbro & Giulio Ferrero

  2. Department of Radiology, Federico II University, Naples, Italy

    Giuseppe Sabino

  3. Department of Radiology, Ospedale Santa Corona, Pietra Ligure, Savona, Italy

    Giovanni Serafini

  4. Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy

    Enzo Silvestri

  5. Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Luca Maria Sconfienza

  6. Department of Biomedical Sciences for Health, Milano University, Milan, Italy

    Luca Maria Sconfienza

Authors
  1. Davide Orlandi
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  2. Angelo Corazza
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  3. Emanuele Fabbro
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  4. Giulio Ferrero
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  5. Giuseppe Sabino
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  6. Giovanni Serafini
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  7. Enzo Silvestri
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  8. Luca Maria Sconfienza
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Correspondence to Davide Orlandi.

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Orlandi, D., Corazza, A., Fabbro, E. et al. Ultrasound-guided percutaneous injection to treat de Quervain’s disease using three different techniques: a randomized controlled trial. Eur Radiol 25, 1512–1519 (2015). https://doi.org/10.1007/s00330-014-3515-0

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  • DOI: https://doi.org/10.1007/s00330-014-3515-0

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