DeQuervain's Tenosynovitis
Conditions
Keywords
DeQuervain's tenosynovitis, splinting, grip strength, satisfaction, DASH questionnaire
Brief summary
DeQuervain's tenosynovitis is characterized by pain on the pain on the radial (thumb) side of the wrist problems with thumb function. At this point, the standard care is to change daily activities, use a thumb brace, and the possible use of painkillers. There is a difference in opinion among physical therapists about how to use the splint in the treatment of DeQuervain tenosynovitis. Some physicians tell patients to wear the brace at all times while other therapists encourage patients to exercise and use the brace as needed. Both approaches to using the splint are accepted as standard. The purpose of this study is to test and evaluate these two ways of splinting and assess which one is better for patients with DeQuervain tenosynovitis.
Detailed description
De Quervain's tenosynovitis (stenosing tenosynovitis of the first dorsal extensor compartment) is characterized by pain on the radial (thumb) side of the wrist and impairment of thumb and wrist function. Histological evaluation is consistent with a chronic rather than an acute tenosynovitis consistent with the often prolonged course of this disease. Nonoperative treatments include modification of activities, splint immobilization, icing and anti-inflammatory medication, and corticosteroid injections. Long opponens splinting (or short arm thumb spica splinting; a splint that immobilizes the wrist and the thumb) is standard and well accepted. There is no consensus on the best protocol for use of the splint. Some authors advocate full time splinting for 4 - 6 weeks, with the rationale that tendonitis will resolve with strict rest. Other authors, perhaps aware of histological evidence that De quervain's is a chronic rather than acute inflammatory condition, feel that the splint serves merely to relieve symptoms and is best used as best suits each individual patient. To our knowledge, there are not data available regarding these disparate views. The ultimate prognosis for recovery in the condition seems satisfying, regardless of the treatment, and spontaneous recovery is the rule. Psychological and personality factors, such as pain anxiety, catastrophizing, and depression are strongly related to upper extremity specific health status and may also influence recovery. The primary goal of this study is to determine which protocol of splinting leads to better outcome in non-surgical treatment of DeQuervain's tenosynovitis. As a secondary goal and to generate hypotheses for later studies we would like to evaluate the influence of psychosocial factors on both objective (grip strength) and subjective (DASH questionnaire) measures of outcome.
Interventions
None listed
Sponsors
Massachusetts General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient (age 18 years or greater) * Physician very confident about the diagnosis of DeQuervain's tenosynovitis.
Exclusion criteria
* Patients with previous history of surgical treatment for De Quervain's. * Skin conditions making splint wear problematic.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire | 8 weeks | The DASH questionnaire measures upper extremity disability on a scale from 0-100, where 0 is no disability and 100 is severe disability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Grip Strength | 8 weeks | Grip strength is measured as a percentage of the non-affected or least affected side. |
| Treatment Satisfaction | 8 weeks | Treatment satisfaction was measured on a scale from 0-10, where 0 is complete dissatisfaction and 10 is complete satisfaction |
| Pain Intensity | 8 weeks | Pain intensity was measured using the Numeric Rating Scale, on a scale from 0-10, where 0 is no pain and 10 is the most pain. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| As-Desired Splinting Subjects who wear the splint as desired | 43 |
| Full Time Splinting Subjects who wear the splint as much as possible | 40 |
| Total | 83 |
Baseline characteristics
| Characteristic | As-Desired Splinting | Full Time Splinting | Total |
|---|---|---|---|
| Age, Continuous | 49.93 years STANDARD_DEVIATION 14.58 | 48.74 years STANDARD_DEVIATION 13.9 | 49.26 years STANDARD_DEVIATION 14.55 |
| Center for Epidemiologic Studies Depression Scale - Revised (CES-D) | 16.3 units on a scale STANDARD_DEVIATION 6.5 | 16.3 units on a scale STANDARD_DEVIATION 8.7 | 16.3 units on a scale STANDARD_DEVIATION 7.6 |
| Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire | 36.5 units on a scale STANDARD_DEVIATION 19 | 33.3 units on a scale STANDARD_DEVIATION 17.8 | 34.96 units on a scale STANDARD_DEVIATION 18.4 |
| Grip Strength | 54.1 percentage of non-affected hand STANDARD_DEVIATION 22.9 | 58.6 percentage of non-affected hand STANDARD_DEVIATION 18.7 | 56.3 percentage of non-affected hand STANDARD_DEVIATION 21 |
| Pain Catastrophizing scale (PCS) | 20.9 units on a scale STANDARD_DEVIATION 8.7 | 17.5 units on a scale STANDARD_DEVIATION 9.5 | 19.3 units on a scale STANDARD_DEVIATION 9.2 |
| Pain Intensity | 5.5 units on a scale STANDARD_DEVIATION 2.3 | 5.8 units on a scale STANDARD_DEVIATION 2.4 | 5.6 units on a scale STANDARD_DEVIATION 2.4 |
| Region of Enrollment United States | 43 participants | 40 participants | 83 participants |
| Sex: Female, Male Female | 36 Participants | 35 Participants | 71 Participants |
| Sex: Female, Male Male | 7 Participants | 5 Participants | 12 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 43 | 0 / 40 |
| other Total, other adverse events | 0 / 43 | 0 / 40 |
| serious Total, serious adverse events | 0 / 43 | 0 / 40 |
Outcome results
Primary
Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire
The DASH questionnaire measures upper extremity disability on a scale from 0-100, where 0 is no disability and 100 is severe disability.
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| As-Desired Splinting | Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire | 28 units on a scale | Standard Deviation 15 |
| Full Time Splinting | Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire | 29 units on a scale | Standard Deviation 20 |
Secondary
Grip Strength
Grip strength is measured as a percentage of the non-affected or least affected side.
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| As-Desired Splinting | Grip Strength | 86 percentage of non-affected hand | Standard Deviation 25 |
| Full Time Splinting | Grip Strength | 87 percentage of non-affected hand | Standard Deviation 18 |
Secondary
Pain Intensity
Pain intensity was measured using the Numeric Rating Scale, on a scale from 0-10, where 0 is no pain and 10 is the most pain.
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| As-Desired Splinting | Pain Intensity | 3.8 units on a scale | Standard Deviation 2 |
| Full Time Splinting | Pain Intensity | 4.4 units on a scale | Standard Deviation 2.9 |
Secondary
Treatment Satisfaction
Treatment satisfaction was measured on a scale from 0-10, where 0 is complete dissatisfaction and 10 is complete satisfaction
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| As-Desired Splinting | Treatment Satisfaction | 6.3 units on a scale | Standard Deviation 2.6 |
| Full Time Splinting | Treatment Satisfaction | 6.4 units on a scale | Standard Deviation 2.9 |