Department of Orthopaedics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, 10300, Bangkok, Thailand.
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Songkhla, 90110, Hat Yai, Thailand.
BMC Musculoskelet Disord. 2022 Sep 1;23(1):831. doi: 10.1186/s12891-022-05784-x.
De Quervain's disease is tenosynovitis of the first dorsal compartment causing severely painful radial-side wrist pain and impaired function. Steroids are effective in treating this condition due to their anti-inflammatory properties. However, this drug causes problems such as hypopigmentation, and is contradicted in diabetes mellitus patients. Non-steroidal anti-inflammatory drug (NSAID) which are efficacious in shoulder pathology and not contraindicated in diabetics and can be used to avoid the local effects of steroids could be beneficial for some patients. The present study was a randomized controlled trial to examine the differences in pain scores and functional response to local injections of a corticosteroid and the NSAID ketorolac.
Sixty-four patients with radial styloid tenosynovitis were randomized using a computer-generated random number table into two groups receiving either a ketorolac injection or a triamcinolone injection. We evaluated post-injection pain intensity using a verbal numerical rating scale (VNRS), functional outcomes using the Thai Disabilities of the Arm, Shoulder and Hand (DASH) scale, and evaluated grip and pinch strengths, recorded at baseline and 6 weeks after the injection.
Thirty-one participants in the ketorolac group and 29 participants in the triamcinolone group completed the study and were included in the analysis. There were no significant differences in the assessments at baseline. At the 6-week conclusion of the study, patients in the triamcinolone group had a statistically lower average pain score than in the ketorolac group (0.7 ± 2.0 vs 5.3 ± 3.2, P < 0.001), higher DASH functional score (4.4 ± 6.5 vs 34.1 ± 20.2, P < 0.001), higher right grip strength (60.8 ± 16.8 vs 49.2 ± 18.6, P < 0.015), and higher left grip strength (59.8 ± 18.1 vs 50.3 ± 18.0, P < 0.04). However, there was no difference in pinch strength.
Our study found that ketorolac injections resulted in inferior pain reduction, functional score and grip improvement than triamcinolone injection in patients with radial styloid tenosynovitis. Future studies are required to examine the effects of ketorolac in larger group and with longer follow-up periods to further elucidate the findings of this study.
The study was registered at Clinicaltrials.in.th (TCTR20200909006).
De Quervain 病是第一背侧间隔的腱鞘炎，导致严重的桡侧腕部疼痛和功能障碍。由于其抗炎特性，类固醇在治疗这种疾病方面非常有效。然而，这种药物会引起色素减退等问题，并且在糖尿病患者中被禁用。非甾体抗炎药（NSAID）在肩部病理学中有效，并且在糖尿病患者中没有禁忌，可以避免类固醇的局部作用，对某些患者可能有益。本研究是一项随机对照试验，旨在检查局部注射皮质类固醇和 NSAID 酮咯酸在疼痛评分和功能反应方面的差异。
64 名患有桡骨茎突腱鞘炎的患者使用计算机生成的随机数表随机分为两组，分别接受酮咯酸或曲安奈德注射。我们使用数字评分量表（VNRS）评估注射后的疼痛强度，使用泰国手臂、肩部和手残疾（DASH）量表评估功能结果，并在基线和注射后 6 周记录握力和捏力。
31 名酮咯酸组和 29 名曲安奈德组的参与者完成了研究并纳入分析。基线时两组评估无显著差异。在研究的 6 周结束时，曲安奈德组患者的平均疼痛评分明显低于酮咯酸组（0.7±2.0 与 5.3±3.2，P<0.001），DASH 功能评分更高（4.4±6.5 与 34.1±20.2，P<0.001），握力更强（60.8±16.8 与 49.2±18.6，P<0.015），左手握力更强（59.8±18.1 与 50.3±18.0，P<0.04）。然而，捏力没有差异。
我们的研究发现，在桡骨茎突腱鞘炎患者中，酮咯酸注射的疼痛缓解、功能评分和握力改善效果不如曲安奈德注射。需要进一步的研究来检查酮咯酸在更大的患者群体和更长的随访期内的效果，以进一步阐明本研究的结果。
该研究在 Clinicaltrials.in.th（TCTR20200909006）注册。
