Ultrasound-guided Injection for DeQuervain's

De Quervain's disease is the stenosing tenosynovitis and tendinitis of the abductor pollicis
longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of
the wrist. While the prevalence of de Quervain's is not yet well-established, previous
studies have shown that women can be affected by the disease up to six times more frequently
than men. Conservative treatments include splinting and corticosteroid injections, but
surgery is an option when such therapy fails. There has been a previous study that compared
the improvement rates of patients treated with splinting alone, injection and splinting, and
injection alone, and found the rate of improvement to be 19%, 57%, 67%, respectively. This
confirmed the good results reported in previous studies and recommends corticosteroid
injection to clinicians as a reliable treatment for de Quervain's disease.

A seminal study performed correlated the accuracy of corticosteroid injection with pain
relief by including X-ray dye in the injection. The results of the study suggested a strong
correlation between accurate injection of the first dorsal compartment and pain relief. Since
then, the use of ultrasonography (US) to guide steroid injection has been suggested as a
possible clinical practice, but little research has been done on the technique. A 2009 study
reported a 93.75% rate of significant pain relief after the use of US-guided injections, but
there was no control group with which to compare results. The current standard practice for
steroid injection in de Quervain's patients is a blind injection without imaging guidance. To
the investigators knowledge, no study has compared the accuracy and clinical outcomes of
blind injections to US-guided injections. The investigators hypothesize that the US-guided
injections will be and will result in greater pain relief for patients than blind injections.

This is intended to be a prospective study. Patients will contact Dr.'s Grindel and Daley for
a standard clinical evaluation, which includes palpation of the first extensor compartment
and application of the Finkelstein test. Those diagnosed with de Quervain's disease and who
fit all inclusion criteria will receive a detailed verbal description of the study from one
of the doctors, who will then attain written, informed consent from willing participants.
Dr.'s Grindel or Daley will then administer either a blind or US-guided injection. The
patient will return for follow-up appointments at 6-8 weeks and 12-16 weeks and will undergo
another physical exam to determine pain relief. A phone call follow-up will also be placed
one year after the injection in order to determine long-term effectiveness. Once 20 study
subjects in each group (40 total) have been enrolled and completed treatment, the data will
undergo statistical analysis.

This study poses minimal or no physical risk to study subjects, as the US-guided injection
should show better pain relief for patients than the current standard treatment (blind
injection).

In summary, the investigators aim to perform a prospective study to evaluate the
effectiveness of blind corticosteroid injections to US-guided injections for the treatment of
de Quervain's disease. The results of the study will be used to validate current injection
protocols or support the incorporation of ultrasonography to treat the disease.

Inclusion Criteria:

- Pain with palpation at 1st dorsal compartment at wrist and positive Finkelstein's Test

Exclusion Criteria:

- Patients with evidence of osteoarthritis or degeneration of the wrist.