Introduction
Materials and methods
Parameter | Patient details | ||
---|---|---|---|
USG guided injection | Surgical release | ||
Gender | Female/total | 26/32 | 21/30 |
Mean age | In years | 46.17 | 49.13 |
Occupation: number | Labourer | 3 | 4 |
Homemaker | 20 | 20 | |
Student | 2 | 0 | |
Desk job | 6 | 4 | |
Nurse | 1 | 2 | |
Dominant hand involvement | 20/32 | 18/30 | |
Right hand involvement | Right hand/total | 23/32 | 22/30 |
Duration of symptoms | |||
Mean (for total patients) | |||
23 weeks( 4–80 weeks) | Upto 3 months | 17 | 14 |
Upto 6 months | 9 | 13 | |
Upto 9 months | 2 | 2 | |
Upto 12 months | 4 | 1 | |
Patients with comorbidities | 4 | 8 | |
Patients with history of injury | Injury/total | 7/32 | 6/30 |
Separate compartment for EPB | Septum/total | 18/32 | 16/30 |
Multipennate APL | Multipennate/total | 29/32 | 19/30 |
Injection technique
Surgical technique
Statistical methodology
Results
Functional outcome
Follow up | DASH | PRWE | VAS | |||
---|---|---|---|---|---|---|
Surgical release | Steroid injection | Surgical Release | Steroid injection | Surgical release | Steroid injection | |
On first consultation | 82.2 ± 11.4 | 81.7 ± 9.5 | 81.5 ± 6.2 | 79.3 ± 7.9 | 6.7 ± 1.2 | 6.8 ± 1.2 |
3 weeks (conservative Mx) | 76.7 ± 12.15 | 73.2 ± 14.7 | 79.6 ± 9.0 | 75.1 ± 10.9 | 4.9 ± 1.8 | 4.8 ± 1.6 |
6 weeks | 5.5 ± 2.7 | 6.6 ± 2.7 | 11.9 ± 5.4 | 9.1 ± 6.5 | 2.2 ± 1.1 | 2.6 ± 1.3 |
6 months | 1.7 ± 1.9 (P < 0.05) | 1.0 ± 1.6 (P < 0.05) | 3.4 ± 2.6 (P < 0.05) | 1.7 ± 2.1 (P < 0.05) | 1.0 ± .0 (P < 0.05) | 1.0 ± .0 (P < 0.05) |
Recurrence
Complications
Discussion
Relevance and importance of ultrasound for steroid injections
Authors | Year | No. of cadavers | Study design | Results (Was USG more accurate?) | Key observations |
---|---|---|---|---|---|
Ultrasound based cadaveric studies | |||||
Leversedge et al. [24] | 2016 | 50 | To evaluate the accuracy in regard to:1) anatomic | -USG evaluation accuracy was higher—94% assessment, 2) needle placement without imaging guidance: 3) ultrasonography-guided injection with priority for the extensor pollicis brevis sub-compartment -When ultrasonography was not used: Accurate needle placement—26/50 wrists (52%), and only 2 of 27 needles (7%) were located within the EPB sub-compartment -Ultrasonography-guided injection—100% accurate (50/50) and EPB injection was 96% accurate (26 of 27) when two compartments were present | A sub-compartment identified in 27/50 wrists; 18 complete and 9 incomplete Minimal extravasation was identified in 6 of 50 wrists (12%) |
Kang et al. [30] | 2017 | 15 | To evaluate the accuracy of USG injection aimed at EPB tendon sheath and anatomical variances influencing the results. Comparison between manual and USG injections in 30 cadaveric wrists | The accuracy was higher in the USG group (93.3%) than in control group (40.0%) The accuracy in manual group without septum (55.6%) was higher than in those with septum. (16.7%). The accuracy between those without septum (100%) and with septum (85.7%) was not significantly different in USG group | Tendency not to have septum was seen in wrists with more EPB or APL tendon slips. All intratendinous injections was occurred in the wrist with 1 EPB tendon slip or 1 or 2 APL tendon slip |
Kutsikovich et al. [32] | 2018 | 43 | To determine the accuracy of USG injections in comparison with anatomical landmark (AL) based injections. Hypothesis: Accuracy of injection would be increased by ultrasound guidance Randomised study of cadaveric specimens to receive latex dye injections either by USG or using AL technique in the 1st dorsal compartment (FDC) | All specimens demonstrated dye within the FDC. Ultrasound identified septated FDC in 6/8 (sensitivity of 75% and specificity of 92%) versus 2/6 in the AL group demonstrating dye infiltration around the EPB. USG injections had a higher observed infiltration rate in EPB sub-compartments than the AL technique. It may help in needle placement in septated FDC Dye noted in the subcutaneous tissues in 2/21 specimens in the USG group vs 2/22 in the AL group | 8/21 specimens in the UG group and 6/22 AL group demonstrated a septated 1st dorsal compartment |
Authors | Year | No. of patients | Follow up | Study design | Results | Complications |
---|---|---|---|---|---|---|
Ultrasound based clinical studies | ||||||
Kume.et al. [19] | 2012 | 44 | 4 weeks | Randomly allocated USG guided and manual injection. Pain evaluation by VAS score at 4 weeks | US-guided injection showed a more significant decrease in VAS score than the manual injection group. two in USG group and nine in manual group underwent surgery at 6 weeks | No adverse events till 6 weeks |
McDermott et al. [23] | 2012 | 40 | 11 months | A prospective consecutive series of patients referred for an ultrasound-guided injection. DASH and VAS scores assessed at follow up | At the 6-week 97% had at least partial resolution of symptoms. Multiple sub-compartments were identified in 52% of cases. No adverse effects were noted | 14% of wrists had recurrence and all of them had sub-compartments on ultrasound |
Hajder et al. [22] | 2013 | 62 | 12.4 months | Retrospective case series of patients who were evaluated after USG guided steroid injection | After two injections, 91% of the patients had good long-term results, | local depigmentation, allergic reaction, paresthesia of the superficial branch of radial nerve |
Keating-Hart et al. [31] | 2016 | 41 | 15.6 months | Prospective, open-label study to find clinical and ultrasound features which could predict the failure of conservative treatment in de Quervain’s syndrome. Ultrasound-guided injection performed in 41 patients | Patients with positive clinical tests, high VAS score and presence of intra-compartmental septum, had a significantly higher risk of failure following conservative treatment | Recurrence in 10/41 |
Bing et al. [25] | 2018 | 28 | 31.7 days | Different steroid USG injection techniques based on anatomical variations of presence of septum of the first extensor compartment and to evaluate its usefulness in patients | 22 out of 23 patients were satisfied with the results with significant drop in pain scores | mild depigmentation noted at the injection site |
Authors | Year | No. of Patients | Follow up | Risks identified | Functional results | |
---|---|---|---|---|---|---|
Results of surgical decompression | ||||||
Scheller et al. [27] | 2009 | 94 | 15.7 years | None reported | All patients had complete relief of symptoms and returned to their normal daily activities. No cases of recurrence | Superficial wound infection, delayed wound healing, transient sensory radial nerve lesion |
Lee et al. [35] | 2014 | 33 | 28.4 months | 18/33 (55%), had separate EPB compartment, A thick retinaculum and neovascularization of the tendon sheath were noted. Small ganglia from the tendon sheaths noted in eight patients | All patients except one improved. average VAS score decreased from 7.42 to 1.33 and DASH from 53.2 to 3.45 postoperatively | One had negative sign on Finkelstein test at the last follow-up There were no postoperative complications |
Garcon et al. [28] | 2018 | 89 | 9.5 years | A supernumerary septum in 50 cases (56%), and APL tendon multiple slips in 35 cases | There were no recurrences. Functional impairment was absent in 68 wrists, Mean VAS was 0.76 | Functional impairment moderate in 8 and significant in 4, dissatisfaction in associated disease cases |
Mangukiya et al. [34] | 2019 | 46 | 3 months | Severe peritendinous adhesions, ganglion within first dorsal compartment | Mean DASH score improved from 42.26 to 5.37, Mean VAS from 7.30 to 2.33 post-operatively | hypertrophic scar, persistent numbness to first dorsal web space due to injury to superficial radial nerve, recurrent symptoms |
Salim et al. [36] | 2021 | 40 | 6 months | Not reported | All patients improved after surgery. (VAS score, Quick DASH Score, and Mayo Wrist Score improved) | tendon subluxation |