Zapalenie pochewek ścięgnistych de quervaina – Rokowania, prognozy i postęp choroby

Zapalenie pochewek ścięgnistych de quervaina
Rokowania, prognozy i postęp choroby

Zapalenie pochewek ścięgnistych de Quervaina to zapalenie obejmujące pochewki ścięgniste w pierwszym przedziale prostowników nadgarstka, dotykające około 1% populacji rocznie. Leczenie iniekcjami kortykosteroidowymi (CS) jest skuteczne u około 82% pacjentów, z ponad 50% utrzymujących remisję przez co najmniej 12 miesięcy. Nawrót objawów występuje głównie w ciągu pierwszych 6 miesięcy, z około 30% wskaźnikiem nawrotów. Iniekcje pod kontrolą USG wykazują porównywalną skuteczność do leczenia chirurgicznego, przy mniejszych kosztach i powikłaniach, umożliwiając jednocześnie diagnostykę anatomiczną i prognozowanie. Standardowo zaleca się unieruchomienie nadgarstka i odpoczynek przez kilka tygodni, a czas gojenia ścięgien wynosi zwykle kilka tygodni, zależnie od nasilenia objawów i przyczyny zapalenia.

Wprowadzenie do prognozy zapalenia pochewek ścięgnistych de Quervaina
Skuteczność leczenia zachowawczego

Iniekcje kortykosteroidowe
Iniekcje pod kontrolą USG
Leczenie zachowawcze bez iniekcji

Czynniki prognostyczne wpływające na skuteczność leczenia

Czynniki anatomiczne
Czynniki ryzyka i ich wpływ na przebieg choroby

Leczenie chirurgiczne i jego rezultaty
Długoterminowe rokowanie i możliwe powikłania

Możliwe powikłania nieleczonego zapalenia

Indywidualizacja podejścia terapeutycznego
Podsumowanie czynników prognostycznych

Kolejne rozdziały

Wprowadzenie do prognozy zapalenia pochewek ścięgnistych de Quervaina

Zapalenie pochewek ścięgnistych de Quervaina to stan zapalny obejmujący pochewki ścięgniste w pierwszym przedziale prostowników nadgarstka. Choroba ta dotyka około 1% populacji w Stanach Zjednoczonych rocznie i jest jedną z najczęstszych form tenosynovitis.¹ Prognoza tej choroby zależy od wielu czynników, w tym zastosowanego leczenia, cech anatomicznych pacjenta oraz czasu od wystąpienia objawów do rozpoczęcia leczenia.

Skuteczność leczenia zachowawczego

Iniekcje kortykosteroidowe

Iniekcje kortykosteroidowe (CS) stanowią skuteczną opcję leczenia zapalenia pochewek ścięgnistych de Quervaina. Badania wykazały, że pojedyncza iniekcja kortykosteroidowa skutecznie łagodzi objawy u około 82% pacjentów, a ponad połowa pozostaje wolna od objawów przez co najmniej 12 miesięcy.² Co istotne, wszystkie przypadki nawrotu objawów występują w ciągu pierwszych 6 miesięcy od iniekcji.³

Nowsze badania wskazują na około 30% wskaźnik nawrotów po iniekcjach kortykosteroidowych, przy jednoczesnej znaczącej poprawie zarówno w skali DASH (Disabilities of the Arm, Shoulder and Hand), jak i w skali VAS (Visual Analog Scale) oceniającej ból.⁴

Iniekcje pod kontrolą USG

Szczególnie obiecujące wyniki uzyskano dla iniekcji kortykosteroidowych przeprowadzanych pod kontrolą USG. W ostatniej dekadzie wyniki badań wskazują, że ta metoda może być rozważana jako potencjalny pierwotny sposób leczenia zapalenia pochewek ścięgnistych de Quervaina.⁵ Badania porównawcze wykazały, że iniekcje pod kontrolą USG są porównywalne do leczenia chirurgicznego pod względem łagodzenia bólu, poprawy funkcji, przy znacznie mniejszych kosztach, mniejszej liczbie powikłań i krótszym pobycie w szpitalu.⁶⁷

Dodatkową zaletą procedury pod kontrolą USG jest możliwość diagnostyki stanu, sprawdzenia zmienności anatomicznej oraz pomoc w doradzaniu pacjentowi co do prognozy schorzenia.⁸ W jednym z badań tylko dwóch pacjentów wymagało operacji nawet po roku obserwacji, co uzasadnia stosowanie iniekcji pod kontrolą USG przed rozważeniem leczenia chirurgicznego.⁹

Leczenie zachowawcze bez iniekcji

Większość pacjentów z zapaleniem pochewek ścięgnistych de Quervaina wymaga noszenia ortezy unieruchamiającej i odpoczynku nadgarstka przez kilka tygodni, aby uzyskać poprawę.¹⁰ Czas gojenia ścięgien po zdiagnozowaniu tego schorzenia zazwyczaj wynosi kilka tygodni, jednak dokładny okres zależy od przyczyny zapalenia i nasilenia objawów.¹¹

Czynniki prognostyczne wpływające na skuteczność leczenia

Czynniki anatomiczne

Warianty anatomiczne mogą w istotny sposób przewidywać powodzenie leczenia. Badania wykazały, że dwa główne czynniki anatomiczne mają kluczowe znaczenie dla powodzenia leczenia zastrzykami kortykosteroidowymi:¹²

Obecność przegrody wewnątrzprzedziałowej w pierwszym przedziale prostowników – istotnie prognozuje niepowodzenie iniekcji CS, ze zwiększonym ryzykiem nawrotu (skorygowany iloraz szans: 18,39, p = 0,045)¹³
Liczba pasm ścięgien – jest również predyktorem nawrotu objawów (skorygowany iloraz szans dla każdego dodatkowego pasma ścięgna: 24,68, p < 0,01)¹⁴

Te anatomiczne czynniki prognostyczne pozwalają lekarzom na bardziej spersonalizowane poradnictwo. Po diagnostycznym badaniu USG pacjenci mogą zostać poinformowani, że mają około 70% szansy na ustąpienie objawów w ciągu sześciu tygodni po iniekcji. Jednak w przypadku stwierdzenia przegrody, prawdopodobieństwo nawrotu zwiększa się około 18-krotnie, a dla każdego dodatkowego pasma ścięgna w przedziale, prawdopodobieństwo wzrasta około 25 razy.¹⁵

Czynniki ryzyka i ich wpływ na przebieg choroby

Czynniki ryzyka zapalenia pochewek ścięgnistych de Quervaina można szeroko podzielić na:

Czynniki anatomiczne – omówione powyżej¹⁶
Czynniki pacjenta – mogą wpływać na przebieg i skuteczność leczenia¹⁷
Czynniki zawodowe – wbrew powszechnym przekonaniom, aktywność związana z pracą zawodową, obejmująca powtarzalne, wymagające siły lub ergonomicznie stresujące prace manualne, nie została jednoznacznie ustalona jako bezpośrednia przyczyna zapalenia pochewek ścięgnistych de Quervaina¹⁸¹⁹

Przegląd systematyczny i metaanaliza obejmująca 80 artykułów nie znalazły dowodów na związek przyczynowy między zapaleniem pochewek ścięgnistych de Quervaina a zawodowymi czynnikami ryzyka, takimi jak powtarzalna, wymagająca siły i ergonomicznie stresująca praca manualna.²⁰ Badacze jak Stahl i współpracownicy stwierdzili, że ekspozycja zawodowa nie może być uznana za predysponujący czynnik ryzyka dla tego schorzenia.²¹

Leczenie chirurgiczne i jego rezultaty

Większość pacjentów nie wymaga zabiegu chirurgicznego w leczeniu zapalenia pochewek ścięgnistych de Quervaina. Jednak lekarze mogą zalecić operację, jeśli inne metody leczenia nie łagodzą objawów.²² Zabieg chirurgiczny jest rzadko stosowany, ale może być konieczny do uwolnienia ciśnienia w pochewkach ścięgnistych.²³

Wyniki leczenia chirurgicznego potwierdzają podobne rezultaty jak w przypadku iniekcji pod kontrolą USG, bez nawrotów i z istotną statystycznie poprawą w zakresie funkcjonalności.²⁴ W porównaniu z innymi metodami leczenia, zabieg chirurgiczny może być rozważany u pacjentów z niekorzystnymi czynnikami anatomicznymi, które znacząco zmniejszają szanse powodzenia leczenia zachowawczego.²⁵

Długoterminowe rokowanie i możliwe powikłania

Zapalenie pochewek ścięgnistych de Quervaina jest bardzo dobrze poddające się leczeniu i zwykle jest problemem krótkoterminowym. Jednak jeśli nie jest leczone, istnieje większe prawdopodobieństwo, że pacjent będzie wymagał operacji lub doświadczy powikłań.²⁶

Możliwe powikłania nieleczonego zapalenia

W przypadku nieleczonego zapalenia pochewek ścięgnistych de Quervaina mogą wystąpić następujące powikłania:

Jeśli wywierany jest zbyt duży nacisk na ścięgna kciuka po wystąpieniu objawów, pochewka ścięgna może pęknąć lub samo ścięgno może ulec rozerwaniu²⁷
W rzadkich przypadkach niektóre osoby z nieleczonym zapaleniem pochewek ścięgnistych de Quervaina mogą trwale utracić część funkcji lub zakresu ruchu w kciuku i nadgarstku²⁸

Indywidualizacja podejścia terapeutycznego

Znajomość czynników prognostycznych umożliwia lekarzom stosowanie bardziej spersonalizowanego podejścia do leczenia. Pacjenci z niekorzystnymi czynnikami anatomicznymi (takimi jak obecność przegrody wewnątrzprzedziałowej lub dodatkowe pasma ścięgien) mogą być wcześniej kierowani do rozważenia leczenia chirurgicznego, jeśli prawdopodobieństwo powodzenia leczenia zachowawczego jest niskie.²⁹

Badanie USG przed podjęciem decyzji o metodzie leczenia może dostarczyć cennych informacji prognostycznych i pomóc w podjęciu optymalnej decyzji terapeutycznej, potencjalnie oszczędzając pacjentowi niepotrzebnych prób leczenia zachowawczego w przypadkach, gdy szanse na powodzenie są niskie.³⁰

Podsumowanie czynników prognostycznych

Prognoza w zapaleniu pochewek ścięgnistych de Quervaina zależy od wielu czynników:

Czas do rozpoczęcia leczenia – wczesna interwencja zwykle prowadzi do lepszych wyników³¹
Warianty anatomiczne – obecność przegrody wewnątrzprzedziałowej i większa liczba pasm ścięgien znacząco zwiększają ryzyko nawrotu objawów³²
Metoda leczenia – zarówno iniekcje kortykosteroidowe (szczególnie pod kontrolą USG), jak i leczenie chirurgiczne wykazują wysoką skuteczność w odpowiednio dobranych przypadkach³³³⁴
Przestrzeganie zaleceń dotyczących odpoczynku i unieruchomienia – ma istotny wpływ na wynik leczenia³⁵

Zrozumienie tych czynników prognostycznych umożliwia lekarzom stosowanie bardziej indywidualnego podejścia do leczenia i lepsze informowanie pacjentów o spodziewanym przebiegu choroby i wynikach leczenia.

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Materiały źródłowe

#1 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#2 De Quervain tendinopathy: survivorship and prognostic indicators of recurrence following a single corticosteroid injection – PubMed
https://pubmed.ncbi.nlm.nih.gov/25936736/
Purpose: To determine short- and long-term success rates of a single corticosteroid injection for de Quervain tendinopathy while identifying prognostic indicators for symptom recurrence and repeat intervention. […] We demonstrated that a single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients and that over half remained symptom-free for at least 12 months. All patients with recurring symptoms developed them within the first 6 months.
#3 De Quervain tendinopathy: survivorship and prognostic indicators of recurrence following a single corticosteroid injection – PubMed
https://pubmed.ncbi.nlm.nih.gov/25936736/
Purpose: To determine short- and long-term success rates of a single corticosteroid injection for de Quervain tendinopathy while identifying prognostic indicators for symptom recurrence and repeat intervention. […] We demonstrated that a single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients and that over half remained symptom-free for at least 12 months. All patients with recurring symptoms developed them within the first 6 months.
#4 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injection is an effective treatment for de Quervain tendinopathy with a 30% recurrence rate and significant improvement in both the DASH score and VAS for pain. The intracompartmental septum and each additional aberrant tendon slip in the first extensor compartment in the US imaging were associated with significantly increased odds of recurrence.
#5 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications. […] We conducted this study to test our hypothesis that USG guided steroid injection is equally effective as surgery. […] The success of USG guided steroid injections as shown in some of the reports in the last decade introduces it as a potential primary mode of treatment for de Quervains tenosynovitis. […] Our results of surgery confirm similar outcomes with no recurrences and improvements in functional outcome scores that were statistically significant. […] However, in our study, USG guided steroid injection provided equally rewarding results as surgery did. […] We observed significant and sustained relief in the patients treated with USG guided steroid injection and the results are comparable with other studies done for the same.
#6 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications. […] We conducted this study to test our hypothesis that USG guided steroid injection is equally effective as surgery. […] The success of USG guided steroid injections as shown in some of the reports in the last decade introduces it as a potential primary mode of treatment for de Quervains tenosynovitis. […] Our results of surgery confirm similar outcomes with no recurrences and improvements in functional outcome scores that were statistically significant. […] However, in our study, USG guided steroid injection provided equally rewarding results as surgery did. […] We observed significant and sustained relief in the patients treated with USG guided steroid injection and the results are comparable with other studies done for the same.
#7 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
The major advantage of a USG guided procedure lies in its ability to diagnose the condition, checking for anatomical variability, while helping in counselling the patient on the prognosis of the condition. […] None of our patients required the need for a surgery even after 1 year of follow-up except two, which justifies the use of USG guided injections ahead of surgery. […] We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief and functional outcome and with far less cost, complications and hospital stay.
#8 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
The major advantage of a USG guided procedure lies in its ability to diagnose the condition, checking for anatomical variability, while helping in counselling the patient on the prognosis of the condition. […] None of our patients required the need for a surgery even after 1 year of follow-up except two, which justifies the use of USG guided injections ahead of surgery. […] We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief and functional outcome and with far less cost, complications and hospital stay.
#9 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
The major advantage of a USG guided procedure lies in its ability to diagnose the condition, checking for anatomical variability, while helping in counselling the patient on the prognosis of the condition. […] None of our patients required the need for a surgery even after 1 year of follow-up except two, which justifies the use of USG guided injections ahead of surgery. […] We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief and functional outcome and with far less cost, complications and hospital stay.
#10 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#11 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#12 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#13 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#14 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#15 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#16 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
Risk factors for DQT can be broadly split into anatomical, patient, and occupational factors. […] When considering occupational factors, a work-related activity involving repetitive, forceful, or stressful manual work is not an established direct cause of DQT, despite leading organizations and litigation firms supporting the converse.
#17 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
Risk factors for DQT can be broadly split into anatomical, patient, and occupational factors. […] When considering occupational factors, a work-related activity involving repetitive, forceful, or stressful manual work is not an established direct cause of DQT, despite leading organizations and litigation firms supporting the converse.
#18 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
De Quervains tenosynovitis (DQT) is described to be an attritional and degenerative process, triggered by stenosing inflammation of the tendon sheath in the first dorsal compartment of the wrist. […] When considering occupational factors, work-related activity has not been shown to be a direct cause of DQT, despite leading organisations supporting the converse. […] The belief that DQT is caused by work-related injury is incorrect, with no study to date establishing any association. […] A systematic review and meta-analysis including 80 articles found no evidence of a causal relationship between DQT and occupational risk factors, such as repetitive, forceful, and ergonomically stressful manual work. […] Stahl et al concluded that occupation exposure could not be shown to be a predisposing risk factor for DQT.
#19 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
Risk factors for DQT can be broadly split into anatomical, patient, and occupational factors. […] When considering occupational factors, a work-related activity involving repetitive, forceful, or stressful manual work is not an established direct cause of DQT, despite leading organizations and litigation firms supporting the converse.
#20 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
De Quervains tenosynovitis (DQT) is described to be an attritional and degenerative process, triggered by stenosing inflammation of the tendon sheath in the first dorsal compartment of the wrist. […] When considering occupational factors, work-related activity has not been shown to be a direct cause of DQT, despite leading organisations supporting the converse. […] The belief that DQT is caused by work-related injury is incorrect, with no study to date establishing any association. […] A systematic review and meta-analysis including 80 articles found no evidence of a causal relationship between DQT and occupational risk factors, such as repetitive, forceful, and ergonomically stressful manual work. […] Stahl et al concluded that occupation exposure could not be shown to be a predisposing risk factor for DQT.
#21 Time to Reconsider Occupation Induced De Quervainâs Tenosynovitis: An Updated Review of Risk Factors | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/36911-time-to-reconsider-occupation-induced-de-quervain-s-tenosynovitis-an-updated-review-of-risk-factors
De Quervains tenosynovitis (DQT) is described to be an attritional and degenerative process, triggered by stenosing inflammation of the tendon sheath in the first dorsal compartment of the wrist. […] When considering occupational factors, work-related activity has not been shown to be a direct cause of DQT, despite leading organisations supporting the converse. […] The belief that DQT is caused by work-related injury is incorrect, with no study to date establishing any association. […] A systematic review and meta-analysis including 80 articles found no evidence of a causal relationship between DQT and occupational risk factors, such as repetitive, forceful, and ergonomically stressful manual work. […] Stahl et al concluded that occupation exposure could not be shown to be a predisposing risk factor for DQT.
#22 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#23 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#24 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications. […] We conducted this study to test our hypothesis that USG guided steroid injection is equally effective as surgery. […] The success of USG guided steroid injections as shown in some of the reports in the last decade introduces it as a potential primary mode of treatment for de Quervains tenosynovitis. […] Our results of surgery confirm similar outcomes with no recurrences and improvements in functional outcome scores that were statistically significant. […] However, in our study, USG guided steroid injection provided equally rewarding results as surgery did. […] We observed significant and sustained relief in the patients treated with USG guided steroid injection and the results are comparable with other studies done for the same.
#25 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#26 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#27 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
If you put too much pressure on your thumb tendons after you start experiencing de Quervains tenosynovitis symptoms, your tendon sheath can burst or your tendon may tear. […] Its rare, but some people with untreated de Quervains tenosynovitis can permanently lose some function or range of motion in their thumb and wrist.
#28 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
If you put too much pressure on your thumb tendons after you start experiencing de Quervains tenosynovitis symptoms, your tendon sheath can burst or your tendon may tear. […] Its rare, but some people with untreated de Quervains tenosynovitis can permanently lose some function or range of motion in their thumb and wrist.
#29 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#30 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
The major advantage of a USG guided procedure lies in its ability to diagnose the condition, checking for anatomical variability, while helping in counselling the patient on the prognosis of the condition. […] None of our patients required the need for a surgery even after 1 year of follow-up except two, which justifies the use of USG guided injections ahead of surgery. […] We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief and functional outcome and with far less cost, complications and hospital stay.
#31 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.
#32 De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success
https://www.mdpi.com/2075-4426/14/9/928
CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options. […] The existence of an intracompartmental septum in the first extensor compartment was predictive of CS injection failure, with increased odds of recurrence (adjusted odds ratio: 18.39, p = 0.045). […] The number of tendon slips was also predictive of symptom recurrence (adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). [...] Our findings guide better counseling of patients with de Quervain tendinopathy. After diagnostic US imaging, we now counsel patients that they have about a 70% chance of experiencing relief of symptoms within six weeks after the injection. In the case of the identification of a septum, we also inform them that the probability of recurrence increases about 18 times, while for any additional tendon slip in the compartment, the probability increases about 25 times. Thus, a more personalized approach to treatment is provided, and the patients may elect to proceed with the surgical release of the first extensor compartment if the probability of success of conservative treatment is low.
#33 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications. […] We conducted this study to test our hypothesis that USG guided steroid injection is equally effective as surgery. […] The success of USG guided steroid injections as shown in some of the reports in the last decade introduces it as a potential primary mode of treatment for de Quervains tenosynovitis. […] Our results of surgery confirm similar outcomes with no recurrences and improvements in functional outcome scores that were statistically significant. […] However, in our study, USG guided steroid injection provided equally rewarding results as surgery did. […] We observed significant and sustained relief in the patients treated with USG guided steroid injection and the results are comparable with other studies done for the same.
#34 De Quervainâs tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release
https://pmc.ncbi.nlm.nih.gov/articles/PMC10020267/
The major advantage of a USG guided procedure lies in its ability to diagnose the condition, checking for anatomical variability, while helping in counselling the patient on the prognosis of the condition. […] None of our patients required the need for a surgery even after 1 year of follow-up except two, which justifies the use of USG guided injections ahead of surgery. […] We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief and functional outcome and with far less cost, complications and hospital stay.
#35 De Quervainâs Tenosynovitis: Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
De Quervains tenosynovitis is painful swelling around your thumb tendons. […] Most people need to wear a splint and rest their wrist for a few weeks to recover. […] Its rare, but you might need surgery to relieve pressure in your tendon sheaths. […] De Quervains tenosynovitis is one of the most common forms of tenosynovitis. Experts estimate that it affects around 1% of people in the U.S. each year. […] Most people dont need surgery to treat de Quervains tenosynovitis. But your provider might recommend surgery if other treatments dont relieve your symptoms. […] It usually takes a few weeks for your tendons to heal after youre diagnosed with de Quervains tenosynovitis. How long youll need depends on what caused the inflammation and how severe your symptoms are. […] De Quervains tenosynovitis is very treatable and is usually a short-term issue. But if its not treated, its more likely that youll need surgery or experience complications.