Betamethasone Versus Ketorolac Injection for the Treatment of DeQuervains Tenosynovitis

Study Overview
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Brief Summary
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The purpose of this study is to determine if corticosteroid injection modifies the natural course of de Quervain tendinopathy compared to a toradol injection.

Detailed Description
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If steroids are effective for Dequervain tenosynovitis because of their anti-inflammatory properties, then there is a reasonable and rational argument to be made for the local injection of NSAIDS (non-steroidal anti-inflammatory drugs) into the first dorsal extensor compartment. Ketorolac is an NSAID that has been proven efficacious in the treatment of another musculoskeletal condition. Moreover, compared to betamethasone (or other injectable corticosteroids), injection of ketorolac decreases the patient exposure to the potential side-effects of corticosteroids, especially that of elevation of blood sugar levels in diabetics.

Official Title
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Betamethason Versus Ketorolac Injection for the Treatment of DeQuervains Tenosynovitis

Conditions
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DeQuervain Tendinopathy

Intervention / Treatment
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* Drug: betamethasone
* Drug: Ketorolac


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of DeQuervain tendinopathy Understands the local language and is willing and able to follow the requirements of the protocol Understands the informed consent and signs the institutional review board/independent ethics committee (IRB/IEC) approved informed consent form Exclusion Criteria: Patients who have an allergy to lidocaine, celestone, or ketorolac, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetylsalicylic acid (ASA) Patients who have an adverse reaction to lidocaine, celestone, or ketorolac (such as severe elevation of blood sugars in diabetics that caused medical complication) Patients who have received a prior steroid injection within the past three months Patients who have had a prior ipsilateral surgery for DeQuervain Tenosynovitis Patients that have a skin lesion at the location of injection (such as trauma, eczema, rash) Patients who have a current infection at the location of injection Patients who have had iontophoresis within three months Patients who are breast feeding, pregnant, or who plan to become pregnant in the next six months

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Betamethasone<br>1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 6 mg/ml betamethasone (Celestone) | Drug: betamethasone<br>* 1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 6 mg/ml betamethasone<br>* Other names: Celestone;|
| Experimental: Ketorolac<br>1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 30 mg/ml of ketorolac (Toradol) | Drug: Ketorolac<br>* 1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 30 mg/ml of ketorolac<br>* Other names: Toradol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analog scale (VAS) of pain with finklestein test | Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain) | 6 weeks post injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analog scale (VAS) of pain with tenderness over tendon | Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain) | pre injection, 2 weeks post injection, 6 weeks post injection | 
| Visual analog scale (VAS) of pain on radial side of wrist | Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain) | pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 month post injection | 
| The Disabilities of the Arm, Shoulder, and Hand Score (DASH) | Patient-reported evaluation of symptoms as well as ability to perform certain activities. Score is 0-100 (higher scores indicate greater disability). Must answer at least 27/30 questions. Score is 1 to 5 per question. Score is then summed and divided by the number of completed questions. subtract 1 from this number then multiply by 25. | pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 months post injection | 
| Veterans-Rand 12 (VR-12) | Quality of life using VR-12 subscores. Physical Health (PCS) subscore and Mental Health (MCS) subscore, not summed. Range reported in weighted units. Both PCS/MCS are score 0-100 with 100 indicating the highest level of health. | pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 months post injection | 
| Pinch Strength |  | pre-injection, 2 weeks post injection, 6 weeks post injection | 
| Grip Strength |  | pre injection, 2 weeks post injection, 6 weeks post injection |