Efficacy of thumb abduction orthosis versus local methylprednisolone acetate injection in De Quervain's tenosynovitis: A randomized controlled trial

Abstract

Context: De Quervain's disease tenosynovitis is a painful inflammation of tendons on the side of the wrist at the base of the thumb. The most common cause is chronic overuse. It can be self-limited and may resolve without intervention. For those individuals with persistent symptoms, nonsurgical modalities such as rest, massage, cold and heat application, splinting, physical therapy, systemic anti-inflammatory drugs, and corticosteroid injections have been tried with variable success. Aims: The aim of this study was conducted to compare the efficacy of thumb abduction orthosis with local methylprednisolone acetate injection for the management of De Quervain's tenosynovitis. Settings and Design: A randomized controlled study was conducted from September 2017 to August 2019, in the Physical Medicine and Rehabilitation Department of a tertiary hospital in Imphal, Manipur. Subjects and Methods: In Group 1, thumb abduction orthosis was applied, and in Group 2, injection methylprednisolone acetate was given in the first dorsal compartment. Treatment effectiveness was measured by visual analog Scale (VAS) for pain and Quick disabilities score of the Arm, Shoulder, and Hand (quick DASH) for functional assessment. Follow-up assessment was done at 1 month, 3 months, and 6 months. Statistical Analysis: Chi-square test, independent t-test, and paired t-test were used for analysis. Results: Out of the total 60 patients, 51 patients were females and 9 were males. There was a significant improvement in both mean VAS scores and Quick DASH scores in both the groups. At 1-month of follow-up, VAS and Quick DASH score in control group significantly improved compared to study group (P < 0.05). However, there was no statistically significant differences between the two groups at 3 months and 6 months follow-up period (P > 0.05). Conclusions: Although methylprednisolone acetate injection has an excellent outcome, thumb abduction orthosis can be an alternative treatment option for De Quervain's disease.