Improved Corticosteroid Treatment of Recalcitrant de Quervain Tenosynovitis With a Novel 4-Point Injection Technique

Abstract

Background: Previously described corticosteroid injection techniques for de Quervain tenosynovitis (DQT) refer to either 1-point or 2-point injection techniques, showing superiority of the latter.

Hypothesis: The authors’ novel 4-point injection technique (point 4 technique) yields more favorable results than do the older techniques.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: The authors treated 2 groups (A and B), each including 24 high-resistance training individuals (randomly allocated to each group) with persistent DQT. Group A received the point 4 technique, and group B, the 2-point injection technique. Follow-up was in 2, 4, 8, and 52 weeks after the first treatment.

Results: After 2 weeks of treatment, 7 group A patients were symptom-free, whereas the rest scored better than their group B counterparts on the DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure, of whom only 1 was symptom-free. Ten group A patients received repeated injections, in contrast to 19 from group B. Four weeks after the first treatment, 13 group A patients were symptom-free, in contrast to 4 from group B. In group A, 2 patients received repeated injections, in contrast to 20 in group B. Eight weeks after the first treatment, 1 group A patient received repeated injection. One group B patient relapsed, whereas 4 opted for surgical decompression and 16 received repeated injections. Fifty-two weeks after the first treatment, 21 patients in group A were symptom-free, 1 was operated on, and 2 relapsed; in group B, 12 were symptom-free, 9 were operated on, 3 relapsed, and 3 received repeated injections.

Conclusion: In high-resistance training athletes, recalcitrant DQT responds more favorably to the novel point 4 technique than to the standard 2-point injection technique.