Evaluation of Effectiveness of Local Anesthetic Injection in Patients With De Quervain Tenosynovitis
Condition: De Quervain Disease
MeSH terms: Tenosynovitis; De Quervain Disease
Study type: Interventional

Summary: 
      De Quervain tenosynovitis is the most common cause of lateral wrist pain. It occurs with
      stenosis of the abductor pollicis longus and extensor pollicis brevis tendons in the first
      dorsal extensor compartment of wrist. When these muscles are contracted, thumb extension is
      observed, so repeated ulnar deviation and thumb extension exacerbates pain. It is seen more
      commonly in middle-aged females and in the dominant hand.

      Although it has been shown that fibrous tissue deposits cause thickening of the tendon
      sheaths, the etiology of de Quervain tenosynovitis is unclear. The prevalence of de Quervain
      tenosynovitis has been reported to be 0.5% in males and 1.3% in females.

      Diagnosis of de Quervain tenosynovitis is based on clinical examination. The Finkelstein test
      is the provocation of pain with wrist ulnar deviation. Plain radiography may be useful for
      differential diagnosis. Conservative treatment of rest, non-steroidal anti-inflammatory drugs
      (NSAID), and physical therapy is applied first, then there may be a need for corticosteroid
      injections, and in resistant cases, surgery.

      Neural therapy (NT) is a type of regulatory therapy using local anesthesia for the management
      of chronic musculoskeletal pain. NT includes local therapy (eg,infiltration of trigger
      points) and segmental therapy (eg, sympathetic ganglia, nerve roots, and peripheral nerves) .
      To the best of our knowledge, the effect of neural therapy on patients with De Quervain
      tenosynovitis has not been previously evaluated. Therefore, the aim of this study was to
      highlight the effect of neural therapy on this condition.
    

Detailed description: 
      In each session, 20 ml of local anesthetic (1:100 mixture of 10 mg/mL procaine) was used.
      Local injections, C5-T8 segmental injections, trigger point injections of the forearm muscles
      and stellate ganglion injections were applied in each session, using a 27-gauge, 4-6 cm
      needle. The local injection was applied first in the first extensor compartment at the point
      of maximal tenderness and was directed proximally toward the radial styloid (3 mL of the
      mixture). Then the forearm muscles were investigated by palpation to determine the trigger
      points. If any trigger point was detected, approximately 5 mL lidocaine was injected to that
      point. C5-T8 segmental injections were applied intradermally to each spinous process and to
      0.5-2 cm lateral of each process on the affected side (approximately 0.25-0.5 ml per
      injection). Finally, the stellate ganglion injection was applied using Fischer's modified
      technique. The sternocleidomastoid muscle was palpated by the physician between the middle
      and distal third, gently pulling the muscle laterally with the neurovascular bundle.
      Following palpation of the anterior tubercle of the transverse process of the sixth cervical
      vertebra, the cervical spine was extended and rotated 45° to the opposite side. The needle
      entry point was 1 mm below the tubercle, then the needle was directed 45° caudally, 45°
      medially and 45° dorsally. If the aspiration was negative, 3mL procaine was injected
    

Intervention name(s): Neural therapy application
Intervention type(s): Procedure
Intervention description(s): Local injections, C5-T8 segmental injections, trigger point injections of the forearm muscles and stellate ganglion injections are applied in each session, using a 27-gauge, 4-6 cm needle. The local injection is applied first in the first extensor compartment at the point of maximal tenderness and is directed proximally toward the radial styloid.trigger point is detected, approximately 5 mL lidocaine was injected to that point. C5-T8 segmental injections are applied intradermally to each spinous process and to 0.5-2 cm lateral of each process on the affected side. Finally, the stellate ganglion injection is applied using Fischer's modified technique.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: De Quervain tenosynovitis; Local anesthetics; neural therapy