Having a Dequervain’s wrist tenosynovitis fail injection means surgery is a distinct possiblity; thumb spica increased success rates. Injection alone was successful in 69% without and 93% with splinting.
J Hand Surg Am. 2013 Dec 3.in press
Corticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis.|
Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, Hashemi-Motlagh K, Saheb-Ekhtiari K, Akhoondzadeh N.
- Injected “40 mg of methylprednisolone acetate (1 cc) with 1 cc lidocaine 2% using an insulin needle (25 or 27 gauge) in the first dorsal compartment at the point of maximal tenderness.”
- combo group – 3 weeks fiberglass cast and injection
- results – injection alone waws successful in 69% cases; injection and casting was successful in 93% of cases.
An earlier study compared casting to injection and casting:
Mehdinasab SA, Alemohammad SA.
Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain’s tenosynovitis.
Arch Iran Med. 2010;13(4):270-274.
- well padded wrist thumb spica cast for 4 weeks
- same injection as above except they specify “about 2 cm above the styloid process of the radius into the first dorsal compartment of the wrist.”
- Results – casting alone successful in 36.1% of cases; injection and casting effective in 86.5% of cases
Comment – looks like if you are serious about treating de quervain’s tenosynovitis, you need to at least splint thumb/wrist for 3-4 weeks after injection.