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Niloofar Akhoondzadeh - One of the best experts on this subject based on the ideXlab platform.
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corticosteroid injection with or without thumb spica cast for De Quervain Tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Mohsen Mardanikivi, Mahmoud Karimi Mobarakeh, Farzaneh Bahrami, Kevyan Hashemimotlagh, Khashayar Sahebekhtiari, Niloofar AkhoondzadehAbstract:Purpose To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for De Quervain tendinitis. Methods In this prospective trial, 67 eligible patients with De Quervain Tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenDerness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, ShoulDer and Hand and visual analog scale scores. Results The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, ShoulDer and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. Conclusions The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of De Quervain Tenosynovitis in terms of treatment success and functional outcomes. Type of study/level of eviDence Therapeutic II.
Scott W Wolfe - One of the best experts on this subject based on the ideXlab platform.
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regarding corticosteroid injection with or without thumb spica cast for De Quervain Tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Scott W WolfeAbstract:To the Editor: I was interested in the January 2014 article by Mardani-Kivi et al concerning the efficacy of a thumb spica cast when used to supplement corticosteroid injection for De Quervain tendinopathy. Their findings differ markedly from those of Weiss et al, that immobilization did not add to the benefit of injection alone, and I applaud the authors for studying this in a prospective fashion. However, I am concerned that the authors used methylprednisolone acetate (Depo-Medrol 40 mg) for their injections. Depo-Medrol, a fat-soluble glucocorticoid preparation, is not specifically indicated for use in subDermal locations in the United States. The package insert contains abundant bold-font warnings concerning the risk of subcutaneous placement of the drug (shown below). A quick review of the literature Demonstrates several serious complications from the injection of fat-soluble corticosteroids in patients with De Quervain disease, including but not limited to subcutaneous atrophy, skin Depigmentation, capillary fragility, bleeding, scar revision, and tendon rupture. Mardani-Kivi et al reported no complications in their series, and I would like to know whether they iDentified any of the complications mentioned above, or others in longer-term follow-up. It is difficult to inject the first dorsal compartment without at least some leakage of the injected material into the surrounding subcutaneous tissue. Most authors document a 2to 3-month lag time before the appearance of skin Depigmentation. I advise consiDerable caution with the use of methylprednisolone acetate injection for the treatment of De Quervain disease. From the package insert LAB-0160-3.0 Pfizer, Inc. (New York, NY), revised August 2008:
Amir Reza Kachooei - One of the best experts on this subject based on the ideXlab platform.
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letter regarding corticosteroid injection with or without thumb spica cast for De Quervain Tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Michael Rivlin, Philip E Blazar, Amir Reza KachooeiAbstract:1. Gregor S, Maegele M, Saurland S, Krahn JF, Peinemann F, Lange S.Negative pressure wound therapy: a vacuum of eviDence? Arch Surg.2008;143(2):189e196.2. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematicreview of topical negative pressure therapy for acute and chronicwounds. Br J Surg. 2008;95(6):685e692.3. Brown KM, Harper FV, Aston WJ, O’Keefe PA, Cameron CR.Vacuum-assisted closure in the treatment of a 9-year-old child withsevere and multiple dog bite injuries of the thorax. Ann Thorac Surg.2001;72(4):1409e1410.4. Durai R, Mownah A, Ng PC. Bridge vacuum-assisted closure: a noveltechnique of using a single vacuum machine for multiple adjacentwounds. Int J Clin Pract. 2010;64(1):93e94.
Mohsen Mardanikivi - One of the best experts on this subject based on the ideXlab platform.
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corticosteroid injection with or without thumb spica cast for De Quervain Tenosynovitis
Journal of Hand Surgery (European Volume), 2014Co-Authors: Mohsen Mardanikivi, Mahmoud Karimi Mobarakeh, Farzaneh Bahrami, Kevyan Hashemimotlagh, Khashayar Sahebekhtiari, Niloofar AkhoondzadehAbstract:Purpose To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for De Quervain tendinitis. Methods In this prospective trial, 67 eligible patients with De Quervain Tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenDerness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, ShoulDer and Hand and visual analog scale scores. Results The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, ShoulDer and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. Conclusions The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of De Quervain Tenosynovitis in terms of treatment success and functional outcomes. Type of study/level of eviDence Therapeutic II.
Bart Berghs - One of the best experts on this subject based on the ideXlab platform.
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De Quervain Tenosynovitis following trapeziometacarpal ball and socket joint replacement
Journal of wrist surgery, 2015Co-Authors: J F Goubau, Laurent Goubau, Chul Ki Goorens, Petrus Van Hoonacker, D Kerckhove, Bert Vanmierlo, Bart BerghsAbstract:Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is De Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the inciDence of De Quervain disease during the first year following surgery. We found a particularly high inciDence (17%) of De Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting De Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the Development of De Quervain tendinopathy within one year after surgery.
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the wrist hyperflexion and abduction of the thumb what test a more specific and sensitive test to diagnose De Quervain Tenosynovitis than the eichhoff s test
Journal of Hand Surgery (European Volume), 2014Co-Authors: J F Goubau, D Kerckhove, L Goubau, A Van Tongel, P Van Hoonacker, Bart BerghsAbstract:De Quervain's disease has different clinical features. Different tests have been Described in the past, the most popular test being the Eichhoff's test, often wrongly named as the Finkelstein's test. Over the years, a misinterpretation has occurred between these two tests, the latter being confused with the first. To compare the Eichhoff's test with a new test, the wrist hyperflexion and abduction of the thumb test, we set up a prospective study over a period of three years for a cohort of 100 patients (88 women, 12 men) presenting spontaneous pain over the radial siDe of the styloid of the radius (De Quervain tendinopathy). The purpose of the study was to compare the accuracy of the Eichhoff's test and wrist hyperflexion and abduction of the thumb test to diagnose correctly De Quervain's disease by comparing clinical findings using those tests with the results on ultrasound. The wrist hyperflexion and abduction of the thumb test revealed greater sensitivity (0.99) and an improved specificity (0.29) together with a slightly better positive predictive value (0.95) and an improved negative predictive value (0.67). Moreover, the study showed us that the wrist hyperflexion and abduction of the thumb test is very valuable in diagnosing dynamic instability after successful Decompression of the first extensor compartment. Our results support that the wrist hyperflexion and abduction of the thumb test is a more precise tool for the diagnosis of De Quervain's disease than the Eichhoff's test and thus could be adopted to guiDe clinical diagnosis in the early stages of De Quervain's tendinopathy.