The Efficacy of Thumb Spica Casting With or Without Corticosteroid Injection for De Quervain's Tenosynovitis

TL;DR

This study shows that combining thumb spica casting with corticosteroid injections is more effective than casting alone for treating De Quervain's tenosynovitis.

Contribution

The study provides new evidence that adding corticosteroid injections to thumb spica casting improves treatment outcomes for De Quervain's tenosynovitis.

Findings

Group A (injection + casting) had an 83.9% success rate compared to 40% in Group B (casting alone).

Pain reduction was significantly greater in the combined treatment group.

Functional improvement, as measured by QuickDASH, was better in the combined treatment group.

Abstract

Background and objective

De Quervain's tenosynovitis is a highly prevalent wrist pathology primarily caused by chronic thumb overuse. Its management typically begins with conservative methods, progressing to corticosteroid injections or surgery if necessary. This study compares the efficacy of thumb spica casting plus corticosteroid injection versus casting alone for treating De Quervain's tenosynovitis.

Materials and methods

This quasi-experimental study was conducted at the Department of Orthopaedics, Khyber Teaching Hospital, Peshawar, and enrolled adults aged 18-50 who presented with De Quervain's tenosynovitis. Patients were assigned to receive either corticosteroid injection plus thumb spica cast (Group A) or thumb spica cast alone (Group B). The primary outcome assessed the treatment success rate, while the secondary outcome evaluated the treatment effectiveness using visual analog scale (VAS) scores and Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH).

Results

Of the initial 65 patients enrolled, 61 completed the study. Group A demonstrated a significantly higher treatment success rate (83.9%, n=26) compared to Group B (40%, n=12) (p<0.001). Pain reduction, as measured by VAS, was markedly greater in Group A (8.4 ± 1.0 to 0.4 ± 0.5) than in Group B (9.0 ± 0.8 to 5.9 ± 1.3) (p<0.001). Similarly, functional improvement assessed by QuickDASH favored Group A (89.6 ± 8.2 to 8.9 ± 6.8) over Group B (84.3 ± 10.1 to 49.1 ± 12.3) (p<0.001). No serious adverse effects related to treatments were noted in either of the groups.

Conclusions

This study supports the superiority of thumb spica casting along with local corticosteroid injection over casting alone for treating De Quervain's tenosynovitis. The combined approach led to significantly better pain relief and functional outcomes, highlighting its effectiveness as a treatment option despite the positive outcomes observed with casting alone.