Are steroid injections effective for tenosynovitis of the hand?

Steroids outperform splinting and NSAIDs. A retrospective study not included in the above review compared steroid injection with splinting and nonsteroidal anti-inflammatory drugs (NSAIDs).⁵ Researchers stratified subjects into minimal, mild, or moderate-to-severe, based on their severity of disease and limitation on their activities of daily living. Mean follow-up was 2.3 years.

Of those cases treated with splinting and NSAIDs, 15 of 17 in the minimal group had resolution of symptoms, but only 4 of 20 in the mild group and 2 of 8 in the moderate-to-severe group had symptoms resolve. The injection group obtained better results, with 100% of cases in the minimal and mild groups resolving and 76% of those in the more severe group resolving completely, with an additional 7% reporting improvement.

Injection site appears to matter with de Quervain’s tenosynovitis. In 1 small, controlled, prospective, double-blinded study, the authors attempted to correlate clinical relief of de Quervain’s tenosynovitis with accuracy of injection into the first dorsal compartment.⁶ The researchers enrolled 19 patients. The same hand surgeon injected 3 cc of 1% lidocaine, 1 cc betamethasone, and 1 cc Omnipaque 300 dye into the abductor pollicis longus sheath and then attempted, with ulnar deviation of the needle, to fill the extensor pollicis brevis sheath.

Patients were followed-up at 1 month and 3 months postinjection. Success—defined as a negative Finkelstein’s test, absence of pain, and normal activities of daily living—was noted in 11 of 19 patients at 3 months. In a radiographic check, 4 of 5 of the patients with dye in both compartments were asymptomatic, while the 3 who had no dye in either compartment remained symptomatic. This suggests that the location of injection may be important in de Quervain’s tenosynovitis.

Recommendations from others

The Brigham and Women’s Hospital guidelines for treatment of de Quervain’s tenosynovitis state that corticosteroid injections “may be very helpful,” and that they should be considered if symptoms persist beyond 6 weeks of conservative treatment.⁷DeLee and Drez’s Orthopedic Sports Medicine text recommends corticosteroid injection for de Quervain’s tenosynovitis after 2 weeks of conservative treatment have failed.⁸

UpToDate recommends steroid injection for de Quervain’s tenosynovitis if pain persists for more than 2 to 6 weeks despite splinting, icing, and NSAID therapy.⁹ For flexor tenosynovitis, UpToDate recommends local injection when symptoms persist for 4 to 6 weeks despite splinting.¹⁰