Factors effecting the success of conservative management in de Quervain cases

Yıl 2018, Cilt: 3 Sayı: 1, 6 - 9, 02.03.2018

Hasan Hüseyin Ceylan Özcan Kaya Barış Çaypınar Muhammed Beşir Öztürk

https://doi.org/10.25000/acem.382440

Cited By: 1

Öz

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.

Anahtar Kelimeler

de-Quervain, conservative management, failure

De Quervain olgularında konservatif tedavi başarısını etkileyen faktörler

Öz

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.

Anahtar Kelimeler

de-Quervain, konservatif tedavi, başarısızlık

Kaynakça

• 1. Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, et al. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum. 2006;55:765-78.
• 2. Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. 2009;34:112-5.
• 3. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, , editors. Green’s operative hand surgery. 7th ed. Wolfe SW, Tendinopathy. Pages: 1916-9. Philadelphia: Elsevier; 2017.
• 4. Robinson BS. Rehabilitation of a cellist after surgery for de Quervain’s tenosynovitis and intersection syndrome. Med Probl Performing Artists. 2003;18:106–12.
• 5. Patel KR, Tadisina KK, Gonzalez MH. De Quervain's Disease. Eplasty. 2013;13:ic52.
• 6. Goel R, Abzug JM. de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015;10:1-5.
• 7. Ilyas A. Nonsurgical treatment of de Quervain’s tenosynovitis. J Hand Surg. 2009;34A:928–9.
• 8. Kazmers NH, Liu TC, Gordon JA, Bozentka DJ, Steinberg DR, Gray BL. Patient and Disease-Specific Factors Associated With Operative Management of de Quervain Tendinopathy. J Hand Surg Am. 2017;42:931.e1-931.e7.
• 9. Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis. Open Orthop J. 2015;9:437-44.
• 10. Hartzell TL, Rubenstein R, Herman M. Therapeutic modalities an updated review for the hand surgeon. J Hand Surg. 2013;37A:597–621.
• 11. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg. 2002;27: 322-4.
• 12. Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15:757–64.
• 13. Jaworski CA, Krause M, Brown J. Rehabilitation of the wrist and hand following sports injury. Clin Sports Med. 2010;29:61–80
• 14. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskelet Disord. 2009;10:131.
• 15. Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am. 1994;19:595-8.
• 16. 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;73:219-22.
• 17. Lee HJ, Kim PT, Aminata IW, Hong HP, Yoon JP, Jeon IH. Surgical release of the first extensor compartment for refractory de Quervain's tenosynovitis: surgical findings and functional evaluation using DASH scores. Clin Orthop Surg. 2014;6:405-9.
• 18. Menendez ME, Thornton E, Kent S, Kalajian T, Ring D. A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. Int Orthop. 2015;39:1563-9.
• 19. Makarawung DJ, Becker SJ, Bekkers S, Ring D. Disability and pain after cortisone versus placebo injection for trapeziometacarpal arthrosis and de Quervain syndrome. Hand (N Y). 2013;8:375-81.
• 20. Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, Hashemi-Motlagh K, Saheb-Ekhtiari K, Akhoondzadeh N. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis. J Hand Surg Am. 2014;39:37-41.
• 21. Goldfarb CA, Gelberman RH, McKeon K, Chia B, Boyer MI. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg Am. 2007;32:1513-20.
• 22. Stepan JG, London DA, Boyer MI, Calfee RP. Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist. J Hand Surg Am. 2014;39:706-12.
• 23. Capasso G, Testa V, Maffulli N, Turco G, Piluso G. Surgical release of de Quervain's stenosing tenosynovitis postpartum: can it wait? Int Orthop. 2002;26:23-5.
• 24. McKenzie JM. Conservative treatment of de Quervain's disease. Br Med J. 1972;4:659-60.