The Warren Alpert Medical School of Brown University, Providence, RI.
The Warren Alpert Medical School of Brown University, Providence, RI.
J Hand Surg Am. 2024 Jun;49(6):532-540. doi: 10.1016/j.jhsa.2024.01.018. Epub 2024 May 4.
Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand.
This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison.
In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls.
TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
合成代谢类固醇治疗与肌腱损伤有关，但将生理睾酮替代疗法（TRT）与手部腱鞘炎（特别是扳机指和 De Quervain 腱鞘炎）联系起来的证据很少。本研究的目的是评估 TRT 与手部腱鞘炎的关系。
这是一项使用大型全国性索赔数据库进行的一对一精确匹配回顾性队列研究。在 2010 年至 2019 年期间，对连续 3 个月开具 TRT 处方的成年患者的记录进行了查询。使用 ICD-9、ICD-10 和当前程序术语计费代码确定新发性扳机指和 De Quervain 腱鞘炎以及随后的类固醇注射或手术的发生率。单变量卡方分析和多变量逻辑回归用于比较 TRT 和对照组的发生率，同时控制潜在的混杂变量。报告了每种比较的未调整和调整后的优势比（OR）。
在调整分析中，接受 TRT 的患者比匹配的对照组发生扳机指的可能性高出两倍多。TRT 也与发生 De Quervain 腱鞘炎的可能性增加有关。在两年期间被诊断为扳机指或 De Quervain 腱鞘炎的患者中，与对照组相比，有 TRT 病史的患者接受类固醇注射或手术松解的可能性大约是两者的两倍。
TRT 与扳机指和 De Quervain 腱鞘炎的发生几率增加有关，并且这两种疾病都更有可能需要手术松解。
研究类型/证据水平：预后 II 类。
