“Ultrasound-guided corticosteroid injections for the treatment of De Quervain’s disease”
Introduction: De Quervain's disease is a disorder of the first extensorcompartment and is primarily treated with corticosteroid injections. This compartment is known for a large anatomical variation. A variation is the presence of a septum, which seems to have a negative impact on the effectiveness of corticosteroid injections. Accurate injection into the different compartments is important for the chances of success. With ultrasound the diagnosis can be confirmed and an accurate injection can be given simultaneously. We expect ultrasound-guided injections to have a higher efficacy rate.
Materials and Methods: In this retrospective study we included patients from the department of Plastic Surgery who were treated with an ultrasound guided corticosteroid injection for De Quervain, in the period from 01/01/2004 till 31/12/2009. The ultrasound examination and injection were performed by one musculoskeletal radiologist. Exclusion criteria were previous wrist surgery, a corticosteroid injection <3 months ago or insufficient follow-up data. Outcome was measured by perceived improvement, chance of recurrence and complications. The results from this study were compared to the results reported in the literature.
Results: From a total of 122 viewed ultrasound reports with suspicion of De Quervain. 51 wrists (47 patients) were included. The mean follow-up was months. After one injection, 94% noted significant improvement, % remained free of symptoms and % developed a recurrence after an average of 10 months. After the second injection 87% of the total remained free of symptoms and the risk of recurrence was 40%. The complication rate was 20%, all adverse events were self-limiting. Results found in literature: relieve of symptoms after one injection 73% (58-84) and after 2 injections 83% (79-91). Chance of complication is 0-38%. Our study also showed that % of the clinical De Quervain diagnoses were not confirmed by ultrasound.
Discussion and Conclusions: Ultrasound-guided corticosteroid injections are a safe and effective treatment for De Quervain's disease. In this study we found no difference in effectiveness between ultrasound-guided and blind injections as reported in literature. However, ultrasound seems to be of value in confirming or rejecting the diagnosis. These results and the very limited available literature on this subject are reasons for us to initiate a RCT comparing ultrasound-guided injections to not ultrasound-guided injection.
Cortisone injections are extremely safe, but they do still have potential problems. If you are concerned about having a cortisone shot, talk with your doctor. While cortisone is a powerful treatment for many orthopedic conditions, there are usually other options that can also be tried. Many doctors will offer an injection as they are quick, easy, and most often effective. However, your doctor should also be able to offer other treatments for inflammation that may also be effective for those that cannot have, or don't want, a cortisone injection.