Comparison of the effectiveness of two splints in the conservative treatment of De Quervain tenosynovitis

Abstract

Purpose: Thumb spica splint and exercise are widely used in the conservative management of De Quervain tenosynovitis. Using the short opponens splint with exercise is an alternative protocol in conservative treatment. Our aim was, to investigate the effectiveness of two different splints in the conservative management of De Quervain tenosynovitis. Methods: Forty subjects with De Quervain tenosynovitis were randomly allocated into two groups. Twenty subjects in the first group were treated with immobilization with thumb spica orthosis and an exercise program. Twenty subjects in the second group were treated with immobilization with the short opponens splint and the same exercise program. The splints were worn throughout the day for three days after which they were used only at night. Treatment was continued for six weeks. Exercises consisted of stretching exercises after the fourth day and tendon gliding and strengthening exercises following the second week. All subjects were assessed before and after treatment. Assessment consisted of pain, tenderness, grasping activities, pinch meter, Minnesota tests, Functional Scale of Upper Extremity. Results: Inter group comparisons showed no difference between the groups for any of the measured parameters (p>0.05). Intra group comparisons for pre-post treatment showed a significant difference in favor of post treatment values in all measured parameters (p<0.05). Conclusion: The results of this study imply that both splints can be used in the conservative management of De Quervain tenosynovitis if they are accompanied by an appropriate exercise program. The short opponens splint can be a choice with providing minimize functional limitation in management of De Quervain tenosynovitis

Keywords

• De Quervain Disease, Splints, Exercise

De Quervain tenosinovitinin konservatif tedavisinde iki splintin etkinliğinin karşılaştırılması

Abstract

Amaç: Başparmak spica ortezi ve egzersiz, De Quervain tenosinovitin konservatif tedavisinde yaygın olarak kullanılmaktadır. Konservatif tedavide, kısa opponens splinti ile egzersiz alternatif bir tedavi protokolü olarak kullanıldı. Amacımız, De Quervain tenosinovitin konservatif tedavisinde iki splintin etkinliklerinin karşılaştırılması idi. Yöntem: De Quervain tenosinoviti olan 40 birey rastgele yöntemle iki gruba ayrıldı. Birinci gruptaki 20 birey, başparmak Spica ortezi ve egzersiz programı ile tedavi edildi. İkinci gruptaki 20 birey ise kısa opponens splinti ile immobilize edilip aynı egzersiz programı ile tedavi edildi. Bireyler splinti, 3 gün boyunca sürekli giydikten sonra sadece geceleri kullandı. Tedavi altı hafta süresince uygulandı. Egzersiz programı, 4. günden itibaren başlanılan germe egzersizlerinden, ikinci haftadan itibaren de tendon kaydırma ve kuvvetlendirme egzersizlerinden oluşmaktaydı. Tüm bireyler tedavi öncesinde ve sonrasında değerlendirildi. Değerlendirme; ağrı, hassasiyet, kavrama kuvveti ve fonksiyonunu, çimdikleyici kuvvet ölçümünü, Minnesota testlerini, üst ekstremite fonksiyon skalasını içermekte idi. Bulgular: Değerlendirilen tüm parametreler açısından gruplar arasında anlamlı bir fark bulunmadı (p>0.05). Fakat gruplar içinde tedavi öncesi ve tedavi sonrası karşılaştırıldığında tüm değerlendirilen parametreler tedavi sonrası lehine anlamlı fark ile sonuçlandı (p

Keywords

• De Quervain hastalığı, Splintler, Egzersiz

References

1. Moore J.S. De Quervain Tenosynovitis:
2. Stenosing tenosynovitis of the first dorsal compartment.
3. ;39:990-1002. Environ Med.
4. Muckart RD. Stenosing tendovaginitis of abductor pollicis longus and extensor pollicis brevis at the radial styloid (De Quervain's disease). Clin Orthop Relat Res. 1964;33:201- 208.
5. Cotton FJ, Movrison GM, Bradford CH. De Quervain’s tendovaginitis. N Engl J Med 1938;219:120-123. radial styloid
6. Ilyas AM, Ast M, Schaffer AA, et al. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15:757-764.
7. Lalonde DH, Kozin S. Tendon disorders of the hand. Plast Reconstr Surg. 2011;128:1-14.
8. Ilyas AM. Nonsurgical treatment for De Quervain's tenosynovitis. Review. J Hand Surg Am. 2009;34:928-929.

9. Lane LB, Boretz RS, Stuchin SA. Treatment of De Quervain’s disease: role of conservative management. J Hand Surg Br. 2001;26:258-260.
10. Peters-Veluthamaningal C, van der Windt DA, Winters JC, et al. Corticosteroid injection for De Quervain’s tenosynovitis. Cochrane Database Syst Rev. 2009;3:CD005616.
11. Hunter JM, Mackin EJ, Callahan AD. Rehabilitation of the hands: surgery and therapy. 5th ed. Mosby, St Louis;2002.
12. Witt J, Pess G, Gelberman RH. Treatment of De Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991;73:219-222.
13. Huang TH, Feng CK, Gung YW, et al. Optimization design of thumbspica splint using finite element method. Med Biol Eng Comput. 2006;44:1105-1111.
14. Hart RG, Kleinert HE, Lyons K A modified thumb spica splint for thumb injuries in the ED. Am J Emerg Med. 2005;23:777-781.
15. Curwin SL. The etiology and treatment of tendinitis. In: Harries M, Williams C eds. Oxford Textbook of Sports Medicine. Oxford University;1996:512-528.
16. El Hawary R, Stanish WD, Curwin SL. Rehabilitation of tendon injuries in sport. Review. Sports Med. 1997;24:347-358.
17. Colditz JC. The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting. J Hand Ther. 2000;13:228-235.
18. Galindo A, Lim S. A metacarpophalangeal joint stabilization splint: the Galindo-Lim thumb metacarpophalangeal joint stabilization splint. J Hand Ther. 2002;15:83-84.
19. Baltacı G, Ergun N, Bayrakcı Tunay V. Spor Yaralanmalarında Egzersiz Tedavisi. 2th ed. Hacettepe Yayınları;2006.
20. Sanders MJ. Ergonomics and the management of musculoskeletal disorders, 2nd ed. St. Louis, MO: Elsevier;2004:331.
21. Alexander RD, Catalano LW, Barron OA, et al. The extensor pollicis brevis entrapment test in the treatment of de Quervain’s disease. J Hand Surg Am. 2002;27:813-816.
22. Kutsumi K, Amadio PC, Zhao C, et al. Finkelstein’s test: a biomechanical analysis. J Hand Surg. 2005;30:130-135.
23. Anakwe RE, Huntley JS, McEachan JE. Grip strength and forearm circumference in a healthy population. 2007;32:203-209. J Hand Surg Eur.
24. Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66:69-74.
25. Stegink Jansen CW, Simper VK, Stuart HG, et al. Measurement of maximum voluntary pinch strength: effects of forearm position and outcome score. J Hand Ther. 2003;16:326-336.
26. Fournier K, Bourbonnais D, Bravo G, et al. Reliability and validity of pinch and thumb strength measurements in de Quervain’s disease. J Hand Ther. 2006;19:2-10.
27. Kayıhan H. Hemiplejide İş ve Uğraşı Tedavisi. 3th ed. Ankara. Hacettepe Üniversitesi Fizik Tedavi ve Rehabilitasyon Yayınları;1999;37-40.
28. Pransky G, Feuerstein M, Himmelstein J, et al. Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale. J Occup Environ Med. 1997;39:1195- 1202.
29. Neumann DA, Bielefeld T. The carpometacarpal joint of the thumb: stability, deformity and therapeutic intervention. J Orthop Sport Phys Ther. 2003;33:386-399.
30. Weiss S, LaStayo P, Mills A, et al. Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment. J Hand Ther 2000;13:218-226.
31. Walker-Bone K, Palmer KT, Reading I, et al. Prevalence and impact of musculoskeletal disordersof the upper limb in the general population. 2004;51:642-651. and Rheumatism
32. Pascarelli EF, Hsu YP. Understanding work- related upper extremity disorders: clinical findings in 485 computer users, musicians, and others. J Occup Rehabil. 2001; 11:1-21.
33. Forget N, Piolette F, Arsenault J, Harris P, Bourbonnais D. Bilateral thumb’s active range of motion and strength in de Quervain’s disease: comparison with a normal sample. J Hand Ther. 2008;21:276-284.
34. Lipscomb PR. Stenosing tenosynovitis at the radial styloid process (de Quervain's disease). Ann Surg. 1951;134:110-115.
35. Kay NR. De Quervain’s disease. Changing pathology or changing perception? J Hand Surg Br. 2000;25:65-69.
36. Clarke MT, Lyall HA, Grant JW, et al. The histopathology of de Quervain’s disease. J Hand Surg Br.1998;23:732-734.