The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study
Öz
Aim: Patients with De Quervain's stenosing tenosynovitis (DQT) experience problems in daily living activities due to the chronic inflammatory process and tenderness around the wrist. This study aimed to compare the effects of prolotherapy and steroid injection on short-term functional outcomes in DQT patients.
Methods: In this retrospective study between January 2022 and 2023, a cohort of 34 patients with complete demographic data and elbow pain and functional scores, which were recorded at pre-treatment, two weeks, and six weeks post-treatment, was divided into the steroid injection (n=17) and prolotherapy (n=17) groups. Demographic and clinical data of all patients were recorded. The outcomes of the Visual Analogue Scale (VAS) score for wrist pain, Quick Disability Assessment of Arm, Shoulder, and Hand Problems (QuickDASH), and the Health Assessment Questionnaire (HAQ) for wrist functions were examined.
Results: Initial assessments did not reveal any differences between groups in terms of VAS (p=0.756), QuickDASH (p=0.168), and HAQ (p=0.615). In the second week post-treatment, there was a significant reduction in VAS, QuickDASH, and HAQ in steroid injection compared to the prolotherapy (p=0.001). This difference continued at sixth-week post-treatment; VAS (p=0.007), QuickDASH (p=0.003), and HAQ (p=0.011) were found to be significantly lower in steroid injection than in the prolotherapy.
Conclusion:Our findings underscore the superior effectiveness of steroid injection compared to prolotherapy in reducing wrist pain and improving functional outcomes in patients with DQT. These findings benefit orthopedic settings in choosing treatment options logically, though further research is needed to understand long-term effects and mechanisms.
Anahtar Kelimeler
De Quervain stenosing tenosynovitis injections steroids prolotherapy
Etik Beyan
Muş Alparslan University Scientific Research and Publication Ethics Committee approved the study (Date: 07.03.2024, Number:134645-5/53).
Destekleyen Kurum
None.
Teşekkür
None.
Kaynakça
- 1. Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg. 2023;107(1):105-14. doi: 10.1007/s12306-022-00735-0
- 2. Ferrara PE, Codazza S, Cerulli S, Maccauro G, Ferriero G, Ronconi G. Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review. Semin Arthritis Rheum. 2020;50(6):1280-90. doi: 10.1016/j.semarthrit.2020.08.006.
- 3. Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus. 2023;15(4):e38079. doi: 10.7759/cureus.38079.
- 4. Morshed T, Emran M, Hasan MI, Ferdous Z, Sarkar D, Rahman Z. Impact of Corticosteroid Injection on The de Quervain’s Tenosynovitis. KYAMC Journal. 2021;12(2):88-91. doi: 10.3329/kyamcj.v12i2.55441.
- 5. Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults. Eur J Orthop Surg Traumatol. 2014;24(2):149-57. doi: 10.1007/s00590-012-1164-z.
- 6. Dwivedi S, Sobel AD, DaSilva MF, Akelman E. Utility of Prolotherapy for Upper Extremity Pathology. J Hand Surg Am. 2019;44(3):236-9. doi: 10.1016/j.jhsa.2018.05.021.
- 7. Chen H, Yuan A. Prolotherapy treatment for Dequervain's Tenosynovitis and Intersection Syndrome. The Journal of Pain. 2015;16(4):S113. doi: 10.1016/j.jpain.2015.01.469.
- 8. Siampa VS, Tan CW. Treatment of de Quervain's Tenosynovitis with Prolotherapy: A Case Report. Journal of Anesthesiology Clinical Research. 2023;4(1):349-54. doi: 10.37275/jacr.v4i1.257.
- 9. Suresh T, Kecha P. Effect of ultrasound, massage therapy and exercises on de-quervain's tenosynovitis. International Journal of Yoga, Physiotherapy Physical Education. 2018;3(3):43-48.
- 10. Homayouni K, Zeynali L, Mianehsaz EJJoMR. Comparison between Kinesio taping and physiotherapy in the treatment of de Quervain's disease. J Musculoskelet Res. 2013;16(04):1350019. doi: 10.1142/S021895771350019X.
- 11. Kumaran NA, Vignesh G, Vignesh A, Vishwanathan A, Subash Y. Comparison of steroid injection vs platelet rich plasma injection in the treatment of de-quervain tenosynovitis. Int J Orthop. 2023;9(1):13-15. doi: 10.22271/ortho.2023.v9.i1a.3269
- 12. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi: 10.1002/acr.20543.
- 13. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-91. doi: 10.1007/s10067-010-1470-y.
- 14. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 Suppl 39):S14-8. PMID: 16273780
- 15. Vaghasia A, Das G, Shrestha A. Fenestration under Ultrasonography Guidance with Hydrodissection for De Quervain’s Tenosynovitis. Journal on Musculoskeletal Ultrasound in Pain Medicine. 2023;8(1):26-8. doi: 10.4103/jmupm.jmupm_12_23
- 16. Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness of Corticosteroid Injections for Treatment of de Quervain's Tenosynovitis. Hand (N Y). 2017;12(4):357-61. doi: 10.1177/1558944716681976.
- 17. 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. doi: 10.2174/1874325001509010437.
- 18. Challoumas D, Ramasubbu R, Rooney E, Seymour-Jackson E, Putti A, Millar NL. Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2023;6(10):e2337001. doi: 10.1001/jamanetworkopen.2023.37001
- 19. Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis. J Hand Ther. 2016;29(1):3-11. doi: 10.1016/j.jht.2015.10.004.
- 20. Suwannaphisit S, Suwanno P, Fongsri W, Chuaychoosakoon C. Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain's tenosynovitis: a double-blind randomized controlled trial. BMC Musculoskelet Disord. 2022;23(1):831. doi: 10.1186/s12891-022-05784-x.
- 21. Huisstede BM, Coert JH, Fridén J, Hoogvliet P; European HANDGUIDE Group. Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study. Phys Ther. 2014;94(8):1095-1110. doi: 10.2522/ptj.20130069.
Proloterapi ve Steroid Enjeksiyonunun De Quervain Tenosinoviti Üzerindeki Etkisi: Retrospektif Sonuç Araştırması
Öz
Amaç: De Quervain stenozan tenosinovitli (DQT) hastalar, kronik inflamatuar süreç ve el bileği çevresindeki hassasiyet nedeniyle günlük yaşam aktivitelerinde problemler yaşamaktadır. Bu çalışmanın amacı DQT hastalarında proloterapi ve steroid enjeksiyonunun kısa dönem fonksiyonel sonuçlar üzerindeki etkilerini karşılaştırmaktır.
Yöntem: Ocak 2022-2023 tarihleri arasında yapılan bu retrospektif çalışmada demografik verileri eksiksiz olan ve tedavi öncesi, tedavi sonrası iki hafta ve altı hafta dirsek ağrısı ve fonksiyonel skorları kaydedilen 34 hastadan oluşan bir kohort steroid enjeksiyonu (n=17) ve proloterapi (n=17) gruplarına ayrıldı. Tüm hastaların demografik ve klinik verileri kaydedildi. El bileği ağrısı için Görsel Analog Skalası (GAS) skoru, el bileği fonksiyonları için Kol, Omuz ve El Problemlerinin Hızlı Engellilik Değerlendirmesi (QuickDASH) ve Sağlık Değerlendirme Anketi (SDA) sonuçları incelendi.
Bulgular: İlk değerlendirmelerde GAS (p=0,756), QuickDASH (p=0,168) ve SDA (p=0,615) açısından gruplar arasında fark yoktu. Tedavi sonrası ikinci haftada, steroid enjeksiyonunda proloterapiye kıyasla GAS, QuickDASH ve SDA'da anlamlı bir azalma görüldü (p=0,001). Bu fark tedavi sonrası altıncı haftada da devam etti; GAS (p=0,007), QuickDASH (p=0,003) ve SDA (p=0,011) steroid enjeksiyonunda proloterapiye göre anlamlı şekilde düşük bulundu.
Sonuç: Elde edilen bulgular DQT'li hastalarda steroid enjeksiyonunun proloterapiye kıyasla el bileği ağrısını azaltmada ve fonksiyonel sonuçları iyileştirmedeki üstün etkinliğinin altını çizmektedir. Bu bulgular, tedavi seçeneklerinin mantıklı bir şekilde seçilmesinde ortopedik çerçeveye fayda sağlamaktadır, ancak uzun vadeli etkileri ve mekanizmaları anlamak için daha fazla araştırmaya ihtiyaç vardır.
Anahtar Kelimeler
De Quervain stenozan tenosinoviti enjeksiyonlar steroidler proloterapi
Etik Beyan
Muş Alparslan Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulu çalışmayı onaylamıştır (Tarih: 07.03.2024, Sayı:134645-5/53).
Destekleyen Kurum
Yoktur.
Teşekkür
Yoktur.
Kaynakça
- 1. Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg. 2023;107(1):105-14. doi: 10.1007/s12306-022-00735-0
- 2. Ferrara PE, Codazza S, Cerulli S, Maccauro G, Ferriero G, Ronconi G. Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review. Semin Arthritis Rheum. 2020;50(6):1280-90. doi: 10.1016/j.semarthrit.2020.08.006.
- 3. Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus. 2023;15(4):e38079. doi: 10.7759/cureus.38079.
- 4. Morshed T, Emran M, Hasan MI, Ferdous Z, Sarkar D, Rahman Z. Impact of Corticosteroid Injection on The de Quervain’s Tenosynovitis. KYAMC Journal. 2021;12(2):88-91. doi: 10.3329/kyamcj.v12i2.55441.
- 5. Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults. Eur J Orthop Surg Traumatol. 2014;24(2):149-57. doi: 10.1007/s00590-012-1164-z.
- 6. Dwivedi S, Sobel AD, DaSilva MF, Akelman E. Utility of Prolotherapy for Upper Extremity Pathology. J Hand Surg Am. 2019;44(3):236-9. doi: 10.1016/j.jhsa.2018.05.021.
- 7. Chen H, Yuan A. Prolotherapy treatment for Dequervain's Tenosynovitis and Intersection Syndrome. The Journal of Pain. 2015;16(4):S113. doi: 10.1016/j.jpain.2015.01.469.
- 8. Siampa VS, Tan CW. Treatment of de Quervain's Tenosynovitis with Prolotherapy: A Case Report. Journal of Anesthesiology Clinical Research. 2023;4(1):349-54. doi: 10.37275/jacr.v4i1.257.
- 9. Suresh T, Kecha P. Effect of ultrasound, massage therapy and exercises on de-quervain's tenosynovitis. International Journal of Yoga, Physiotherapy Physical Education. 2018;3(3):43-48.
- 10. Homayouni K, Zeynali L, Mianehsaz EJJoMR. Comparison between Kinesio taping and physiotherapy in the treatment of de Quervain's disease. J Musculoskelet Res. 2013;16(04):1350019. doi: 10.1142/S021895771350019X.
- 11. Kumaran NA, Vignesh G, Vignesh A, Vishwanathan A, Subash Y. Comparison of steroid injection vs platelet rich plasma injection in the treatment of de-quervain tenosynovitis. Int J Orthop. 2023;9(1):13-15. doi: 10.22271/ortho.2023.v9.i1a.3269
- 12. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-52. doi: 10.1002/acr.20543.
- 13. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-91. doi: 10.1007/s10067-010-1470-y.
- 14. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 Suppl 39):S14-8. PMID: 16273780
- 15. Vaghasia A, Das G, Shrestha A. Fenestration under Ultrasonography Guidance with Hydrodissection for De Quervain’s Tenosynovitis. Journal on Musculoskeletal Ultrasound in Pain Medicine. 2023;8(1):26-8. doi: 10.4103/jmupm.jmupm_12_23
- 16. Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness of Corticosteroid Injections for Treatment of de Quervain's Tenosynovitis. Hand (N Y). 2017;12(4):357-61. doi: 10.1177/1558944716681976.
- 17. 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. doi: 10.2174/1874325001509010437.
- 18. Challoumas D, Ramasubbu R, Rooney E, Seymour-Jackson E, Putti A, Millar NL. Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2023;6(10):e2337001. doi: 10.1001/jamanetworkopen.2023.37001
- 19. Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis. J Hand Ther. 2016;29(1):3-11. doi: 10.1016/j.jht.2015.10.004.
- 20. Suwannaphisit S, Suwanno P, Fongsri W, Chuaychoosakoon C. Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain's tenosynovitis: a double-blind randomized controlled trial. BMC Musculoskelet Disord. 2022;23(1):831. doi: 10.1186/s12891-022-05784-x.
- 21. Huisstede BM, Coert JH, Fridén J, Hoogvliet P; European HANDGUIDE Group. Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study. Phys Ther. 2014;94(8):1095-1110. doi: 10.2522/ptj.20130069.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2024 |
| Gönderilme Tarihi | 20 Mart 2024 |
| Kabul Tarihi | 23 Nisan 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 8 Sayı: 1 |
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