RANDOMIZED CONTROLLED TRIAL
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Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain's tenosynovitis.

BACKGROUND: There is no consensus in the treatment of de Quervain's tenosynovitis, but wrist support with or without local corticosteroid injection has been considered as an effective treatment modality. Some patients have expressed reluctance for steroid injections because of the fear of probable adverse reactions. This study was performed to compare the outcome of methylprednisolone acetate injection plus thumb spica cast versus cast alone for the treatment of de Quervain's tenosynovitis.

METHODS: This randomized prospective study was conducted from January 2005 to July 2008 in the orthopedic clinics of our hospital and private offices. A total of 73 patients with de Quervain's tenosynovitis were managed with either of these methods: 1) injection of methylpredmisolone acetate in the first dorsal compartment of the wrist followed by wrist thumb spica cast. 2) casting alone. Wrist casting duration in both groups was one month and the patients were followed for 6 months.

RESULTS: In the first group, a total of 37 patients were included (injection plus wrist immobilization by cast), and 36 patients in the second group (wrist casting alone). The mean age was 32.6 years (21 - 61 years) in all patients. There were 63 women and 10 men. Overall success rate was 86.5% in the first and 36.1% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P<0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in 40% of patients. Despite this adverse reaction which was related to methylprednisolone injection, a higher success rate was seen in the injection group in comparison to patients treated solely by casting.

CONCLUSION: Support of the wrist with casting alone had less favorable outcome in de Quervain's tenosynovitis. Adding methylprednisolone acetate injection into the first dorsal compartment of the wrist is necessary for more optimal results.

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