Local Corticosteroid Injection for Treatment of de Quervain's Disease

Abstract

Local Corticosteroid Injection for Treatment of de Quervain's Disease

Paisan Apimonbutr MD

Department of Orthopaedics, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis

de Quervain’s disease is a common pathologic condition in clinical practice. Local corticosteroid injection is an effective conservative treatment. Most reports suggest intrasynovial sheath injection technique, in which the corticosteroid is injected into the synovial sheath of abductor pollicis longus and extensor pollicis brevis tendon. However, this method is difficult with risk of failure due to a mislocated injected site outside the synovial sheath as well as into the tendon leading to a tendon rupture. These risks vary directly to the number of injections. Hence, most patients who have recurrence after 2-3 times of the intrasynovial sheath injection would be recommended to have surgical treatment. The other technique of local corticosteroid injection, which is easier and has comparable result to intrasynovial sheath injection technique, is suprafibrous injection technique in which the corticosteroid is injected on the fibrous roof of the first extensor compartment of the wrist. The advantage of this latter technique is that it can be re-treated with unlimited numbers of injection in recurrences without a risk of tendon rupture.

Keywords: de Quervain's disease, corticosteroid injection, intrasynovial sheath injection, suprafibrous injection