Smartphone usage behaviors and their association with De Quervain's Tenosynovitis (DQT)among college students: a cross-sectional study in Guangxi, China.

BACKGROUND: The growing prevalence of smartphone use among college students in China has led to health concerns, including De Quervain's Tenosynovitis (DQT). However, the specific smartphone usage behaviors contributing to DQT remain poorly understood. This study aimed to explore the relationship between smartphone usage behaviors and DQT in college students. METHODS: A cross-sectional study was conducted with 937 students from various majors in Guangxi between September 2021 and April 2022. Participants completed an online questionnaire assessing smartphone usage behaviors and their association with DQT. The Finkelstein test was employed to diagnose DQT. RESULTS: Over half of the college students (52%) tested positive for DQT via Finkelstein's test. Higher levels of smartphone usage time (6-8 h/day: OR = 4.454, 95%CI:1.662-12.229; ≥8 h/day: OR = 4.521, 95%CI:1.596-12.811), phone games (OR = 1.997, 95%CI:1.312-3.040), social media (OR = 2.263, 95%CI:1.795-3.833), and leisure activities (OR = 1.679, 95%CI:1.140-2.475) were significantly associated with an increased risk of DQT. Two specific gestures (Bilateral thumbs, BT: OR = 1.900, 95%CI:1.281-2.817; Bilateral thumbs-horizontal screen, BT-HS: OR = 1.872, 95%CI:1.244-2.818) and two screen sizes (5.0-5.5inch: OR = 2.064, 95%CI:1.108-3.846; 6.0-6.5inch: OR = 2.413, 95%CI:1.125-4.083) also exhibited a higher risk of DQT. Bilateral DQT was observed, with Gesture-BT identified as the primary risk factor. CONCLUSION: Our findings suggest that increased smartphone usage time, phone games, social media, and leisure activities elevate the risk of DQT among college students. Furthermore, two specific gestures and two screen sizes were also linked to a heightened DQT risk. To mitigate DQT development, college students should reduce smartphone usage time and adopt appropriate gestures.

de Quervain's Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study.

Introduction: de Quervain's disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain's disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain's disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain's disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain's disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain's disease was similar when compared to other studies conducted in similar settings. Keywords: de Quervain's disease; surgery; tenosynovitis.

Preferred treatment approach to De Quervain Tenosynovitis in nursing women: conservative management or surgery?

OBJECTIVE: We aimed to show the effectiveness of different treatment methods in the prevention of clinical symptoms and recurrence of De Quervain Tenosynovitis (DQT), which is often seen in nursing women. PATIENTS AND METHODS: Three different treatment methods were used in 124 patients, all of whom were breastfeeding women who visited our clinic between 2017-2022 with a positive Finkelstein test and DQT. Group I comprised 56 patients who underwent surgical treatment under local anesthesia, Group II, 41 patients who received steroid injections as conservative treatment, and Group III, 27 patients who received wrist splints. The patient files of all groups were reviewed retrospectively, and the effects of the treatment methods on clinical symptoms and recurrence were investigated in patients who were followed up at the 2nd, 4th and 8th weeks. RESULTS: The recurrence rate of Group I patients, which were treated surgically, was significantly lower than that of Group II and III (p=0.0001). Among those who received conservative treatment, patients in Group II had significantly lower recurrence rates than those in Group III. At the 8th week of treatment, clinical symptoms had improved by 96.45%, 58.5%, and 7.4% in Groups I, II, and III, respectively. CONCLUSIONS: It is thought that the repetitive movements made during baby care and the edema that develops in breastfeeding women prepare the ground for DQT. Surgery is the most effective treatment method for the improvement of clinical symptoms and prevention of recurrence.

Partial Resection of First Dorsal Compartment Extensor Retinaculum in De Quervain's Stenosing Tendovaginitis Release.

Various surgical techniques exist to treat de Quervain's stenosing tendovaginitis. Specific surgical techniques for de Quervain's are designed to avoid complications including injury to branches of the superficial branch of the radial nerve, inadequate decompression, reflex sympathetic dystrophy, and palmar subluxation of the released tendons. A simple dorsal incision through the extensor retinaculum is advocated by many as a means to release the compartment while preventing postoperative subluxation. A single incision through the retinaculum limits exposure of the compartment and could lead to reannealing of the retinaculum and recurrent symptoms. Partial resection of the extensor retinaculum provides a more complete release and has not been found to lead to palmar tendon subluxation.

The Radial Synergy Test: An Aid to Diagnose de Quervain's Tenosynovitis.

BACKGROUND: Diagnosis of de Quervain's tenosynovitis is made clinically. Finkelstein's and Eichoff's tests are commonly utilized examination maneuvers. Their specificity has been questioned due to a propensity to provoke pain in asymptomatic patients. Using the principle of synergism, the novel radial synergy test takes advantage of isometric contraction of the first dorsal compartment with resisted abduction of the small finger. METHODS: Electromyography was performed on 3 authors and the first dorsal compartment sampled during the maneuver. Sensitivity evaluation was performed via retrospective chart review for patients diagnosed with de Quervain's from 2013 to 2018. Inclusion criteria were documented radial synergy test, Eichoff's test, and ≥90% pain relief after lidocaine/corticosteroid injection. We enrolled 222 patients with 254 affected extremities. Specificity evaluation was performed via a prospective cohort of volunteers undergoing radial synergy and Eichoff's tests. Inclusion criterion was lack of preexisting wrist pain. Score > 0 on Visual Analog Scale was considered positive. We enrolled 48 volunteers with 93 tested extremities. RESULTS: Electromyography revealed positive recruitment of the first dorsal compartment. Sensitivity of the radial synergy test was inferior to Eichoff's test (97% vs 91%, relative risk [RR] = 0.93 [95% confidence interval [CI] = 0.89-0.97], P < .01). Specificity of the radial synergy test was superior to Eichoff's test (99% vs 74%, RR = 1.33 [95% CI = 1.18-1.51], P < .001). CONCLUSIONS: We describe and evaluate the radial synergy test, a novel examination maneuver to aid the diagnosis of de Quervain's. This serves as an adjunct for future diagnostic evaluations with its high specificity. LEVEL OF EVIDENCE: Level II, diagnostic study.

Reliability of Extensor Pollicis Brevis (EPB) Entrapment Test in Identifying a Separate Compartment for EPB in Patients with de Quervain Disease.

Background: The presence of a separate compartment for the extensor pollicis brevis tendon (EPB) has an implication in the treatment outcome for de Quervain disease. The EPB entrapment test, proposed by Alexander and colleagues, claims to correlate with the presence of a separate compartment for EPB. The purpose of our study is to evaluate the reliability of the EPB entrapment test in predicting a separate compartment for EPB in patients with de Quervain disease. Methods: This was a prospective observational study involving 50 consecutive patients who underwent de Quervain release by a single surgeon. Preoperatively, EPB entrapment test was performed by the operating surgeon. The outcome of the test was recorded and the presence of a separate compartment for the EPB was determined during surgery. Sensitivity, specificity, positive predictive value and negative predictive value of the EPB entrapment test was determined. Results: EPB entrapment test was positive in 28 of 50 patients. In 21 of them, a separate compartment for the EPB was noted. The positive predictive value of the test was found to be 75.8%. The test had a false positive rate of 26.9%, a false negative rate of 12.5%, sensitivity of 87.5% and specificity of 73%. There is a significant association between a positive EPB entrapment test and the presence of a separate compartment for the EPB (p value <0.001). The sensitivity of the test increases to 95.8% if pain on both extension and abduction of the thumb is considered a positive response. Conclusions: The EPB entrapment test is a reliable clinical test to look for the presence of a separate compartment for EPB. Considering the response of pain on both extension and abduction of the thumb further improves the sensitivity of the test. Hence, we suggest including this response also as a positive test. Level of Evidence: Level II (Diagnostic).

Common Hand Conditions: A Review.

Importance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability. Observations: Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments. Conclusions and Relevance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.

De Quervain Tenosynovitis: An Evaluation of the Epidemiology and Utility of Multiple Injections Using a National Database.

PURPOSE: We hypothesized that repeat injections are associated with a decreased rate of success and that the success rate of injections correlates with patient comorbidities. METHODS: Using a commercially available insurance database, patients diagnosed with De Quervain tenosynovitis were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes and stratified by therapeutic interventions, including therapy, injections, and surgery, as well as comorbidities. Injection failure was defined as a patient receiving a repeat injection or subsequent surgical management. Success was defined as no further therapies identified after an intervention. RESULTS: From 2007 to 2017, 33,420 patients with a primary diagnosis of De Quervain tenosynovitis were identified. Women represented 77.5% (25,908) of the total and were 2.6 times more likely to be diagnosed than men. Black patients were more likely to be diagnosed than White patients. Black and White women were found to have the highest incidence (relative risk 3.4 and 2.3, respectively, compared with White men). Age was also significantly correlated with an increased risk of diagnosis of the condition, with a peak incidence at the age of 40-59 years (relative risk, 10.6). Diabetes, rheumatoid arthritis, lupus, and hypothyroidism were associated with an increased risk of diagnosis. Overall, 53.3% of the patients were treated with injections, 11.6% underwent surgery, and 5.2% underwent therapy. Treatment with a single injection was successful in 71.9% of the patients, with 19.7% receiving a repeat injection and 8.4% treated with surgery. The overall success rate of subsequent injections was 66.3% for the second injection and 60.5% for the third. The initial injection had a higher rate of success in diabetics than in nondiabetics; however, the difference (2%) was not clinically relevant. CONCLUSIONS: Although the success rate for the treatment of De Quervains tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Modified Staged Finkelstein Test for the Identification of Intracompartmental Septum in Patients with De Quervain's Disease.

Background: The intracompartmental septum isolating the extensor pollicis brevis (EPB) has been reported to affect the patient's response to nonsurgical treatment in de Quervain's disease. A simple physical test called the modified staged Finkelstein test was developed to evaluate the septum; the result of this test was compared with those of the pre-existing physical test (EPB entrapment test) and ultrasonographic (US) examination of the septum. Methods: We retrospectively analyzed 52 patients who underwent two clinical tests, including the modified staged Finkelstein test and the EPB entrapment test, and US examination for de Quervain's disease. The correlation between the clinical test results and US findings was evaluated; sensitivity, specificity, and positive and negative predictive values were calculated. Results: The proportion of wrists with a separate septum was 50% (26 patients) in the US examination. The sensitivity and specificity of the modified staged Finkelstein test were 88.5% and 73.1%, respectively; those of EPB entrapment test were 71.4% and 84.2%, respectively. The positive and negative predictive values of the modified staged Finkelstein test were 76.7% and 86.4%, respectively. Conclusions: The modified staged Finkelstein test showed acceptable diagnostic values for the diagnosis of septum compared with pre-existing physical tests. Knowledge about the existence of septum could be helpful in treating patients and expecting prognosis.

Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain's Tenosynovitis?

BACKGROUND: Psychological factors such as depression, pain catastrophizing, kinesiophobia, pain anxiety, and more negative illness perceptions are associated with worse pain and function in patients at the start of treatment for de Quervain's tenosynovitis. Longitudinal studies have found symptoms of depression and pain catastrophizing at baseline were associated with worse pain after treatment. It is important to study patients opting for surgery for their condition because patients should choose surgical treatment based on their values rather than misconceptions. Psychological factors associated with worse patient-reported outcomes from surgery for de Quervain's tenosynovitis should be identified and addressed preoperatively so surgeons can correct any misunderstandings about the condition. QUESTION/PURPOSE: What preoperative psychosocial factors (depression, anxiety, pain catastrophizing, illness perception, and patient expectations) are associated with pain and function 3 months after surgical treatment of de Quervain's tenosynovitis after controlling for demographic characteristics? METHODS: This was a prospective cohort study of 164 patients who underwent surgery for de Quervain's tenosynovitis between September 2017 and October 2018 performed by 20 hand surgeons at 18 centers. Our database included 326 patients who underwent surgery for de Quervain's tenosynovitis during the study period. Of these, 62% (201 of 326) completed all baseline questionnaires and 50% (164 of 326) also completed patient-reported outcomes at 3 months postoperatively. We found no difference between those included and those not analyzed in terms of age, sex, duration of symptoms, smoking status, and workload. The mean ± SD age of the patients was 52 ± 14 years, 86% (141 of 164) were women, and the mean duration of symptoms was 13 ± 19 months. Patients completed the Patient-Rated Wrist Evaluation (PRWE), the VAS for pain and function, the Patient Health Questionnaire for symptoms of anxiety and depression, the Pain Catastrophizing Scale, the Credibility/Expectations Questionnaire, and the Brief Illness Perceptions questionnaire at baseline. Patients also completed the PRWE and VAS for pain and function at 3 months postoperatively. We used a hierarchical multivariable linear regression model to investigate the relative contribution of patient demographics and psychosocial factors to the pain and functional outcome at 3 months postoperatively. RESULTS: After adjusting for demographic characteristics, psychosocial factors, and baseline PRWE score, we found that only the patient's expectations of treatment and how long their illness would last were associated with the total PRWE score at 3 months postoperatively. More positive patient expectations of treatment were associated with better patient-reported pain and function at 3 months postoperatively (ß = -2.0; p < 0.01), while more negative patient perceptions of how long their condition would last were associated with worse patient-reported pain and function (timeline ß = 2.7; p < 0.01). The final model accounted for 31% of the variance in the patient-reported outcome at 3 months postoperatively. CONCLUSION: Patient expectations and illness perceptions are associated with patient-reported pain and functional outcomes after surgical decompression for de Quervain's tenosynovitis. Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. Prospective studies are needed to investigate whether addressing patient expectations and illness perceptions, with decision aids for example, can improve patient-reported pain and function postoperatively in those patients who still choose surgery for de Quervain's tenosynovitis. LEVEL OF EVIDENCE: Level III, therapeutic study.

[Treatment of De Quervain's tendinopathy with conservative methods]. / A De Quervain-féle tendinopathia kezelése konzervatív módszerekkel.

Introduction: De Quervain's tendinopathy affects the region of the wrist and the hand. Thumb motion becomes painful. This illness is caused by a degenerative process rather than inflammation. Primary treatment methods are splinting, taking non-steroid anti-inflammatory drugs and different physical therapeutic modalities, administration of a steroid injection into the tendon sheath or surgical release of the tendon sheath may be performed. Aim: The aim of the present study was to investigate whether conservative treatment complemented by eccentric training could provide an adequate alternative to the currently accepted treatment options. Method: The eccentric training lasted for 8 weeks (if necessary for 12 weeks). Following the introduction to exercises, patients (n = 9) repeated the training several times a day, which was controlled during weekly meetings. At the 1st, 8th and 12th meetings, inspection and the following measurements were performed: range of motion, muscle strength, evaluation and number of painful regions including the completion of patient questionnaires. Data were analysed with paired samples t-tests and repeated measures ANOVA. IBM SPSS Statistics 25.0 and Microsoft Office Excel Professional Plus 2016 programs were used. Results were regarded significant at level of p<0.05. Results: Significant improvements were found in the intensity of pain (Numeric Pain Rating Scale p = 0.005, n = 9) and in the functionality of the hand and wrist (Quick Disabilities of the Arm, Shoulder and Hand questionnaire part 1. p<0.001, part 2. p<0.001, Patient-Rated Wrist Evaluation questionnaire p<0.001; n = 9). Conclusion: With careful patient selection, conservative treatment complemented by eccentric training could be an alternative to current treatment options. Orv Hetil. 2020; 161(11): 419-424.

'The side of my wrist hurts': De Quervain's tenosynovitis.

BACKGROUND: Radial-sided wrist pain is a common patient complaint that can have a dramatic effect on the patient's productivity at work, sporting or artistic pursuits and activities of daily living. OBJECTIVE: The aim of this article is to outline key principles in the assessment and treatment of De Quervain's tenosynovitis. DISCUSSION: The correct diagnosis of this debilitating tendon condition and the seeking of early treatment yields excellent outcomes for patients. While there are numerous possible aetiologies, the pathophysiology is defined as a stenosing condition of the first dorsal compartment. Assessment elicits pain over the radial styloid that is caused by the restricted glide of the tendons. Ultrasonography has been shown to be useful in diagnosis and treatment planning, especially if an intercompartmental septum is present. Treatment involves corticosteroid injections and orthoses prescriptions. These should not be used in isolation; many other therapy techniques have been shown to be effective in the management of De Quervain's tenosynovitis.

Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming.

OBJECTIVE: To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS: We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS: Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION: Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.

One portal endoscopic release of the first extensor compartment in de Quervain's disease.

OBJECTIVES: We aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. MATERIALS AND METHODS: The patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. RESULTS: The mean operating time was 13.9 min (range, 10-21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. CONCLUSIONS: One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. LEVEL OF EVIDENCE: Level IV Therapeutic Study.

Anomalous course and stenosing tenosynovitis of the extensor pollicis longus tendon at the radial styloid process: A case report.

RATIONALE: Anomalous course and tenosynovitis of extensor pollicis longus (EPL) tendon is a rare condition that presents clinical symptoms very similar to de Quervain's disease. Herein we report a case of anomalous course and tenosynovitis of the extensor pollicis longus (EPL) tendon associated with symptoms of de Quervain's disease. PATIENT CONCERNS: A 44-year-old right-handed man visited the clinic because of radial pain associated with the left wrist, which was aggravated during the previous 10 days. The patient tested positive on the Finkelstein's test and displayed a limited range of motion of the left wrist. Motion of the thumb and wrist aggravated pain. DIAGNOSES: Magnetic resonance imaging (MRI) of the left wrist suggested mild tenosynovitis at the third extensor compartment and intersection syndrome. However, clinical symptoms failed to match the MRI findings. INTERVENTIONS: A zig-zag skin incision on the radial styloid process was made. The operative findings revealed stenosing tenosynovitis with partial tearing. Retraction of the tendon extended the thumb interphalangeal joint, suggesting that the tendon was the EPL tendon rather than EPB tendon. After operation, we reviewed the MRI of the patient, which revealed that the oblique course of the EPL tendon originated from the ulnar side of the forearm to the radial styloid at the radial and proximal site of Lister's tubercle. No EPB tendon was present. OUTCOMES: At 12 months of follow-up, the patient's radial styloid process was completely asymptomatic and resumed full daily activities. LESSONS: Anomalous course of the EPL tendon is rarely reported associated with similar symptoms of de Quervain's disease. However, the knowledge and understanding of this potential anomaly in the course of EPL tendon is very important for the treatment of de Quervain's disease to decrease patient dissatisfaction after surgery.

Psychologic Factors Do Not Affect Placebo Responses After Upper Extremity Injections: A Randomized Trial.

BACKGROUND: Studies on how psychologic factors influence the placebo effect have shown conflicting results in an experimental setting. Pessimists are more likely to experience a nocebo effect (feel worse after an inert intervention), whereas other studies suggest that patients with more symptoms of depression or anxiety or greater neuroticism have a greater response to a placebo. This is important because treatment benefits are potentiated by placebo effects, and optimal utilization of this phenomenon may improve clinical outcomes. QUESTIONS/PURPOSES: (1) What psychologic factors are associated with a decrease in magnitude of limitations (Disabilities of the Arm, Shoulder and Hand [DASH] score) and pain intensity (visual analog scale [VAS] for pain) after placebo injections for the treatment of painful nontraumatic upper extremity conditions? (2) What psychologic factors are associated with achieving a minimum clinically important difference (MCID) in disability and pain intensity? METHODS: We performed a secondary analysis of data acquired in two prospective, double-blind, randomized controlled trials of patients with lateral elbow pain, trapeziometacarpal arthrosis, and de Quervain tendinopathy who received a single injection of dexamethasone and lidocaine or lidocaine alone (placebo). One hundred six patients were included between June 2003 and February 2008. Sixty-three patients (59%) received dexamethasone and lidocaine, and we analyzed the subset of 43 patients (41%) who received lidocaine alone. The primary outcomes of interest were the DASH questionnaire and the VAS for pain measured three times: when they received the injection, between 1 and 3 months after the injection, and between 5 and 8 months after the injection. Seven patients missed the first followup visit and 14 patients missed the second visit. Based on previous research, we chose a MCID threshold of 10 for the DASH and a threshold of 1.0 for the VAS score. In bivariate analysis, we accounted for sex, race, marital status, degree, education, work status, pretreatment pain, diagnosis, symptoms of depression (Center of Epidemiologic Studies-Depression Scale), coping strategies in response to nociception (Pain Catastrophizing Scale), and personality traits (measured with the Multidimensional Health Locus of Control scale and the Eysenck Personality Questionnaire-Revised score). Variables with p values < 0.10 in bivariate analysis were included in the multivariable regression models. An a priori power analysis showed that a sample of 43 participants provides 80% statistical power, with α set at 0.05, for a regression with five predictors if the depression score would account for 15% or more of the variability in pain score. We used multiple imputations (imputations = 50) for a total of 66 (8.5%) missing or incomplete questionnaires. RESULTS: In the final multivariable models, no psychologic factors were associated with a change in DASH score between injection and followup, and no factors were associated with greater decrease in pain intensity. After injection, no psychologic factors were independently associated with achieving a MCID in the DASH and VAS. CONCLUSIONS: Our study confirms that patient factors are less important mediators of the placebo effect than clinician factors. In other words, clinician warmth and competence can help diminish symptoms and limitations of people in various states of mind, even when using inert or ineffective treatments. LEVEL OF EVIDENCE: Level II, therapeutic study.

Preiser disease after repeated local glucocorticoid injections: A case report.

RATIONALE: Preiser disease or avascular necrosis (AVN) of the scaphoid causes intolerable wrist pain and malalignment of the carpal bones. In previously reported cases, patients have had a history of steroid use for systemic illness such as autoimmune hemolytic anemia, systemic lupus erythematosus, or renal transplantation, or have had other risk factors, such as smoking, alcoholism, or infection. In particular, systemic glucocorticoid therapy has been most commonly associated with the disease. Although there are reports of AVN of the scaphoid induced by systemic glucocorticoids, no prior report has associated AVN of the carpal bones with repeated local injections of glucocorticoids. PATIENT CONCERNS: We present a case in which it was strongly suspected that AVN of the scaphoid was induced by repeated local glucocorticoid injections. The patient had no history of excessive alcohol use, smoking, or trauma, except for local repeated steroid injections. DIAGNOSES: Initially, she had diagnosed with de Quervain's disease and was treated by repeated local glucocorticoid injections followed by surgery for de Quervain's disease. Five years after surgery for de Quervain's disease, the patient presented at our hospital with sudden onset of intolerable pain in her right wrist without a history of trauma. In spite of nonsurgical treatment with rest, immobilization, analgesia, and surgery, her wrist pain was not improved. After further repeated local steroid injections in her wrist, radiographs, and magnetic resonance imaging of her wrist showed the AVN of the scaphoid. INTERVENTIONS: Surgery was performed and the fragmented proximal scaphoid and the entire lunate were resected. OUTCOMES: The diagnosis was confirmed according to the histopathological examination of the proximal scaphoid bone, which showed the characteristic of AVN of the scaphoid. At follow-up evaluation, radiographs of the right wrist showed no progression of osteoarthritis. The patient had no tenderness or residual pain at the wrist and had no desire to pursue additional surgery. LESSONS: We have presented a case with AVN of the scaphoid, which was strongly suspected to be associated with the repeated local steroid injections. Further studies are required to more fully elucidate the association between AVN of the scaphoid and repeated local steroid injections.

Anatomical variations in the first extensor compartment: a cadaver study.

BACKGROUND: Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. METHODS: The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. RESULTS: In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. CONCLUSION: Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.