Real-world Expectations: Injections for de Quervain’s in Patients with Diabetes

What’s the Claim

Among patients who have both diabetes and de Quervain tenosynovitis, injecting the first dorsal compartment with corticosteroids resulted in 49% of patients not having another shot or going on to surgery. A second shot helped 66% of the remainder, and a third shot helped 67% of those with persistent symptoms. About one in five patients opted for surgical release for persistent symptoms after one or more corticosteroid injections.

How’s It Stack Up?

It’s a bit difficult to tell how this compares with other studies on the topic, since papers on this topic — including this one — often have soft spots or important gaps in scientific reporting. Certainly the 49% statistic seems lower than what other studies on corticosteroid shots for de Quervain’s have reported; on the other hand, the second two shots here are right in the ballpark of what others have found, or at least close to it. The problem is that the definition of success here (no more shots, no surgery) was pretty loose. In addition, 11% of the patients were lost to follow-up, and it’s reasonable to surmise that a higher proportion of those patients either had more shots or surgery elsewhere, because the missing usually are not doing as well as the accounted for in studies of this sort.

What’s Our Take?

For those reasons, this paper probably overestimates the benefit of shots in these patients. Pharmacologic placebos are reported to deliver benefits in about 35% or more of patients, and surgical placebos help about half the patients in placebo-controlled surgical trials. One can surmise that placebo injections probably lie somewhere in between those figures. If we discount the percentages these authors reported by the percentage of patients lost to follow-up, we may start to wonder how much better these shots are than placebos, in terms of the magnitude of the effect. That said, corticosteroid shots are commonly used in patients with de Quervain’s and diabetes, perhaps for good reason — patients with diabetes are at higher risk for complications of first dorsal compartment release as well as other hand procedures. Timing of surgery after injection is something else to keep in mind, as well; if you’re going to operate after injecting a hand with corticosteroids, evidence from other minor procedures suggests it’s worth waiting at least a month, and perhaps more, particularly in patients with diabetes whose risk of infection likely is greater. One way or the other, though, it appears likely that two to three injections for de Quervain tenosynovitis will keep a patient with diabetes from opting for surgery, and that's a good, practical discovery.

Source

Buddle VP, DeBernardis D, Lutsky KF, Beredjiklian PK, Matzon JL. Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. J Hand Surg Am. 2022;47:979-987.