Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease

Background: Ultrasonography (US)-guided corticosteroid injection (CI) has been attempted to improve injection accuracy in de Quervain's disease (dQD), but its role in improving clinical outcomes and decreasing skin hypopigmentation or atrophy was not established well. Hypothesis: We hypothesized that the US-guided CI is superior to blind CI in symptom improvement and development of skin hypopigmentation or atrophy. Patients and methods: Forty-four patients (48 wrists) with dQD received ultrasonography-guided CI (24 wrists/22 patients, group A) or blind CI (24 wrists/22 patients, group B) between December 2016 and February 2018. The visual analogue scale for pain and the Patient-rated Wrist Evaluation (PRWE) were used for evaluation. Skin hypopigmentation or atrophy was evaluated using the modified Vancouver scar scale (mVSS). Results: At 4 weeks post-injection, pain and PRWE scores improved for 22 wrists in group A and 21 wrists in group B. At 3 months post-injection, 10.0% (2/20) and 26.3% (5/19) of wrists in group A and B, respectively, had symptom recurrence after initial improvement. Improvement and aggravation rates were not significantly different between the groups. The incidence of skin hypopigmentation or atrophy was 69.6% (16/23 wrists) and 70.0% (14/20 wrists) in group A, and 59.1% (13/22 wrists) and 78.9% (15/19 wrists) in group B at 4 weeks and 3 months post-injection, respectively. The mean mVSS scores at the injection site in group A and B were 2.0 (0-4.0) and 1.8 (0-5.0) at 4 weeks post-injection and 2.4 (0-7.0) and 2.9 (0-6.0) at 3 months post-injection, respectively. The incidence and severity of skin hypopigmentation or atrophy were not significantly different between the groups at both time points. Discussion: Pain and clinical outcomes significantly improved after CI in dQD. Pain, clinical outcomes, and the incidence and severity of skin hypopigmentation or atrophy were not significantly different between ultrasonography-guided and blind CI. (C) 2019 Elsevier Masson SAS. All rights reserved.