Keywords
Corticosteroid injection
Surgical release
Visual Analog Scale
How to Cite
Abstract
Objective: De Quervain tenosynovitis is a frequent cause of radial-sided wrist pain in clinical practice and is a stenosing tendinopathy involving the first dorsal extensor compartment of the wrist. Corticosteroid injection and surgical release are widely used for its treatment; however, there is a lack of comparative evidence on the effectiveness of these treatments in a real clinical setting.
Methods: In this prospective, non-randomised, single-centre comparative study (ClinicalTrials.gov: NCT07683429), 100 patients with clinically diagnosed De Quervain tenosynovitis who failed to respond to initial conservative treatment were enrolled. Forty-nine patients were allocated to corticosteroid injection (CSI), and 51 to open surgical release (OSR) treatment, based on the investigators' clinical judgment and patient choice. The Visual Analogue Scale (VAS, 0-10) was used to measure pain severity at baseline, 1 month, and 6 months after the intervention. Independent samples t-tests were used to compare the differences between groups, and a linear mixed-effects model was used to model pain trajectories over time. The normality of continuous variables was checked before parametric analysis using the Shapiro-Wilk test. A trained assessor blinded to the treatment allocation performed the VAS assessments at follow-up.
Results: Most of the cohort (72%) were women, and the mean age was 36.7 ± 8.0 years. There were no significant differences in age or sex between the two groups; however, the VAS scores were slightly higher in the surgical group (8.71 ± 1.06) than in the CSI group (8.27 ± 0.97; p = 0.033) at baseline. The surgical release group had significantly lower pain scores at 1 month (1.49 ± 0.78) than the CSI group (3.22 ± 1.07; p < 0.001). This difference persisted and widened at six months (surgical: 0.59 ± 0.57 versus CSI: 2.88 ± 1.18; p < 0.001). There was a significant group × time interaction (p < 0.001) for the linear mixed-effects modelling for pain scores over follow-up, indicating that the surgical release group had greater and more lasting reductions in pain. No significant complications were observed in either group.
Conclusion: Corticosteroid injection and open surgical release are effective treatments for De Quervain tenosynovitis. Surgical release was more effective and long-lasting in relieving pain, particularly in cases of chronic or intractable pain. However, corticosteroid injection remains a minimally invasive first-line treatment. Treatment decisions should be based on the severity of symptoms, patient preference, and available resources.
Keywords: De Quervain tenosynovitis; corticosteroid injection; surgical release; visual analog scale; prospective non-randomized comparative study.
References
De Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. American journal of orthopedics (Belle Mead, NJ). 1997 Sep 1;26(9):641-4.
Anandha Geethan KS, Athiban Siva Subin DA, Ramkumar Reddy K. A comparative study of open surgery versus steroid injection in the management of De Quervain tenosynovitis. Int J Contemp Med Res. 2022;9(6):F1-F6.
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 Aug 1;94(8):1095-110. https://doi.org/10.2522/ptj.20130069
Skef S, Ie K, Sauereisen S, et al. Treatments for de Quervain Tenosynovitis. Am Fam Physician 2018;97:Online.
Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for De Quervain tenosynovitis in adults. Eur J Orthop Surg Traumatol. 2014 Feb;24(2):149-57. https://doi.org/10.1007/s00590-012-1164-z
Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskeletal surgery. 2023 Mar;107(1):105-14. https://doi.org/10.1007/s12306-022-00735-0
Cevik J, Keating N, Hornby A, Salehi O, Seth I, Rozen WM. Corticosteroid injection versus immobilisation for the treatment of De Quervain tenosynovitis: A systematic review and meta-analysis. Hand Surg Rehabil. 2024 Jun 1;43(3):101694. https://doi.org/10.1016/j.hansur.2024.101694
Batra A, Elbaz M, Batra J. Role and efficacy of corticosteroid (40 mg methyl prednisolone acetate) injection for non-surgical treatment of de-quervains tenosynovitis, and incidence of complications of the procedure in 55 limbs: A retrospective study. International Journal of Orthopaedics. 2023;9(3):423-6. https://doi.org/10.22271/ortho.2023.v9.i3f.3453
Keidan T, Saleh S, Svorai Band S, Gannot G, Oron A. DE QUERVAIN TENOSYNOVITIS-CLINICAL PRESENTATION AND TREATMENT. Harefuah. 2022 Nov 1;161(11):706-8.
Raza W, Bakar A, Awan S, Qadir RI. Outcome of steroid injections in patients with de-Quervain’s tenosynovitis. J Med Sci. 2020 Jul 29;28(2):162-6.
Stahl S, Vida D, Meisner C, Stahl AS, Schaller HE, Held M. Work related etiology of De Quervain tenosynovitis: a case-control study with prospectively collected data. BMC Musculoskelet Disord. 2015 May 28;16(1):126. https://doi.org/10.1186/s12891-015-0579-1
Shahzad K, Khan RD, Iqbal S, Zahid FM, Israr M, Aslam B. Comparison of intralesional corticosteroid injection with and without thumb Spica cast for de-Quervain tenosynovitis. The Professional Medical Journal. 2021 Oct 31;28(11):1682-6. https://doi.org/10.29309/TPMJ/2021.28.11.4732
Wai-si TE, Joanne Y, Yu LK, Lun YK, Christian F, Pui NS. De Quervain Tenosynovitis: A Systematic and Citation Network Analysis Review. Biomed J Sci Tech Res. 2020;24(5):18674-84. https://doi.org/10.26717/BJSTR.2020.24.004125.
Omoke NI, Nnadozie UU. Clinical outcome of nonoperative treatment of De Quervain disease with local corticosteroid injection in Nigerian setting. Nigerian Journal of Surgery. 2019;25(2):146-52. https://doi.org/10.4103/njs.NJS_10_19.
Alam KQE, Sahu N, Muhammed JC, Bakode H, Kohli GBS. Comparative efficacy of release surgery versus steroid injection in the management of De Quervain tenosynovitis: a randomized controlled trial. Int J Pharm Clin Res. 2024;16(12):58-62.
Ismail D, Paresh D, Mohit D, Sudhanshu D, Swapnil D. Comparative study between surgical release and local steroid injection in treatment of De Quervain disease. Int J Orthop Sci. 2023;9(3A):1-4. https://doi.org/10.22271/ortho.2023.v9.i3a.3404
Garçon JJ, Charruau B, Marteau E, Laulan J, Bacle G. Results of surgical treatment of De Quervain tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthop Traumatol Surg Res. 2018 Oct 1;104(6):893-6. https://doi.org/10.1016/j.otsr.2018.04.022.
Morshed T, Ferdous MZ, Atiquzzaman MD, Sarkar D, Sen AK. Outcome of surgical resection of De Quervain stenosing tenosynovitis. Clin Pract. 2020;17:1482-5. https://doi.org/10.37532/2044-9038.2020.17(3).419.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Saad Riaz, Osama Ijaz, Abdur Rehman, Talha Farooq, Ali Asad Ullah