Factors effecting the success of conservative management in de Quervain cases

Abstract

Aim: De Quervain’s disease, which is known as tenosynovitis of the first radial dorsal compartment, usually is a self-limiting condition and it could be managed conservatively. In this study, we aimed to evaluate the factors affecting the success of the conservative treatment.

Methods: Patients who admitted to outpatient service with radial styloid pain and diagnosed as de Quervain’s disease between March 2014 and December 2016 were enrolled to our study. A total number of 84 patients evaluated retrospectively, and 12 of them excluded due to inadequate patient information, previous interventions in other clinics, and lost to follow up. Patients’ files with regard to the patients’ data on age, sex, duration of symptomatic period, history of previous trauma, season of admission and need of surgery were evaluated.

Results: Mean age of the patients was 42.24 (range 16-66) years. Of the cohort, 58 patients (80.6%) were female and the remaining patients (19.4%) were male. Mean length of pre-admission symptomatic period was 2.2 (range 1-12) months. There was no significant correlation between the resistance to treatment and the duration of the symptoms (r=0.4597). Sixty-one of 72 patients (84.7%) received one month of orthosis and oral/local medication and they were all healed. The remaining 11 patients with persistent pain received additional steroid injections. The mean age was 46.72 years at the injection group, and 10 of these 11 were female. Two female patients from these 11 resistant cases underwent surgical decompression. 

Conclusion: In conclusion, our study also supported the self-limiting clinical feature of de Quervain’s disease. Most of the patients have satisfactory results with conservative treatment or corticosteroid injections if needed. Most of the patients who needed corticosteroid injections in addition to splint use were female; therefore, the female patients should be informed in this aspect.

Keywords

• de-Quervain,conservative management,failure

De Quervain olgularında konservatif tedavi başarısını etkileyen faktörler

Abstract

Amaç: Birinci dorsal kompartmanın tenosinoviti olan de Quervain hastalığı sıklıkla konservatif olarak tedavi edilebilen bir antitedir. Bu çalışmamızda konservatif tedavi başarısını etkileyen parametreleri tartışmayı amaçladık.

Yöntemler: Mart 2014- Aralık 2016 tarihleri arasında el bileği radial stiloidde lokalize ağrı ile polikliniğimize başvuran ve de Quervain tanısı alan hastaların verilerine ulaşıldı. Ulaşılan 84 hastadan, başvuru öncesinde dış merkezde müdahale edilen veya enjeksiyon yapılan,  detaylı anamnezine ulaşılamayan ve ikinci kontrole gelmeyen 12’si çalışma dışı bırakıldı. Toplam 72 de Quervain hastası çalışmamıza dahil edildi. Hastaların yaşları, cinsiyetleri, semptomatik periyodun uzunluğu, travma anamnezi, başvurunun yapıldığı mevsim ve cerrahi gereksinimi sorgulandı.

Bulgular: Hasta grubu yaş ortalaması 42,24 (aralık 16-66) yıl olarak saptandı. Hastalardan 58’i kadın (%80.6) ve 14’ü erkekti (%19,4). Başvuru öncesi ortalama semptomatik periyodun 2,2 (aralık 1-12) ay olduğu görüldü. Bu periyodun uzunluğu ile tedaviye direnç arasında anlamlı ilişki saptanmadı (r=0,4597). 72 hastanın 61’inin (%84,7) bir aylık istirahat ateli ve oral ve topikal antienflamatuar tedavi ile iyileştiği saptandı. Diğer 11 hastanın semptomlarının devam ettiği görüldü ve tamamına lokal kortikosteroid enjeksiyonu yapıldı. Enjeksiyon ihtiyacı duyulan hastaların 10’unun kadın olduğu ve cerrahi tedaviye ihtiyaç duyan hastaların tamamının kadın olduğu görüldü. Enjeksiyon grubunun yaş ortalaması 46,72 yıl olarak saptandı. Takip eden kontrollerde bu 11 hastanın ikisinin enjeksiyona rağmen semptomlarda gerileme olmadığı ve cerrahi dekompresyon yapıldığı saptandı.

Sonuç: Çalışmamız de Quervain hastalığının kendini sınırlayıcı niteliğini teyit etmektedir. Hastaların çoğunluğu konservatif tedavi ya da kortikosteroid enjeksiyonu ile tedavi edilebilmektedir.  Başvuran hastamız kadınsa medikal tedavi ve atele ilave olarak enjeksiyon tedavisi gerekebileceği hastaya anlatılmalıdır.

Keywords

• de-Quervain,konservatif tedavi,başarısızlık

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