Comparing the Efficacy of Local Corticosteroid Injection and High-Intensity Laser Therapy in Patients with De Quervain Tenosynovitis

EXTENDED ABSTRACT

Background

De Quervain tenosynovitis is an inflammatory disorder of the tendon sheath in the first extensor compartment of the wrist, involving the extensor pollicis longus and abductor pollicis brevis, and is associated with repeated tendon trauma [1–3]. Pregnancy and repetitive or forceful wrist movements are recognized risk factors [2,3]. The disorder is more common in women, with reported prevalence of 1.3% in women and 0.5% in men, and most often affects adults aged 30-55 years [4–7]. Patients commonly present with pain, tenderness, and swelling near the radial styloid [4], and pain may radiate to the thumb, forearm, or shoulder [8, 9]. Diagnosis is primarily clinical [9], with a positive Finkelstein test described as characteristic [4]. Conservative management includes rest and immobilization [1, 2, 9, 10, 11], thermal modalities [9, 11], nonsteroidal anti-inflammatory drugs [10, 12, 13], local corticosteroid injection [9–14], kinesiotaping [4], and laser therapy [1, 4, 5, 15, 16]; surgery may be used when conservative treatment fails [9, 11]. Local corticosteroid injection has reported therapeutic benefit but may cause adverse effects such as skin depigmentation and atrophy [3,4]. Laser therapy is a noninvasive modality used for musculoskeletal conditions, and high-intensity systems can deliver greater output energy and deeper tissue penetration than low-level devices [17–19]. Because evidence directly comparing high-intensity laser therapy with local corticosteroid injection for De Quervain tenosynovitis was limited, this randomized clinical trial compared their effects on tendon thickness, pain, quality of life, and treatment satisfaction.

Methods

This randomized controlled clinical trial included 30 patients with De Quervain tenosynovitis who attended the Physical Medicine Department of Besat Hospital, Hamadan, during 2022-2023. Patients were recruited consecutively by convenience sampling after ultrasound confirmation of the diagnosis and provision of voluntary informed consent, and were randomly allocated to two groups of 15. Eligibility criteria included age 18-65 years, at least three months since diagnosis, and a pain intensity of at least 3. Patients with other wrist disorders such as rheumatoid arthritis or osteoarthritis, or those receiving nonsteroidal anti-inflammatory treatment, were excluded.

The high-intensity laser group received a gallium-aluminum-arsenide diode laser at 1064 nm, an output power of 8 W, mean energy density of 4 J/cm², and pulsed delivery at 50 Hz using a scanning technique. Treatment consisted of five sessions lasting 5-7 minutes each, separated by three-day intervals. The local corticosteroid group received a single ultrasound-guided injection of 40 mg triamcinolone plus 1 mL of 2% lidocaine. Outcomes were assessed before treatment, four weeks after treatment, and 12 weeks after treatment. Tendon-sheath thickness was measured by ultrasonography with a linear 3-12 MHz probe and recorded in millimeters. Pain intensity was assessed with the Visual Analogue Scale [20], and quality of life with the SF-12 questionnaire [21]. Patient and treating-physician satisfaction were also evaluated after treatment. Data were analyzed in SPSS version 26 using Student t test, Mann-Whitney test, repeated-measures analysis of variance, and Fisher exact test, with P<0.05 considered significant. The Ethics Committee of Hamadan University of Medical Sciences approved the study (IR.UMSHA.REC.1401.745).

Results

The two groups were comparable at baseline. Mean age was 37.93 ± 11.64 years in the high-intensity laser group and 33.37 ± 9.24 years in the corticosteroid group (P=0.241), while mean body mass index was 25.50 ± 5.54 and 26.27 ± 3.11 kg/m², respectively (P=0.541). Women represented 80.0% of the laser group and 93.3% of the corticosteroid group (P=0.598). Tendon thickness decreased over time in both groups. In the corticosteroid and laser groups, respectively, mean thickness was 7.57 ± 0.63 and 7.25 ± 0.58 mm before treatment (P=0.120), 6.55 ± 0.61 and 6.54 ± 0.40 mm at one month (P=0.955), and 5.71 ± 0.75 and 5.99 ± 0.45 mm at three months (P=0.239). Repeated-measures analysis showed a significant time effect (P=0.021), but no significant time-by-group interaction (P=0.174) or overall group effect (P=0.105).

Table 1. Mean tendon thickness before treatment and at one and three months in patients with De Quervain tenosynovitis, by treatment group.

Pain improved markedly in both groups. Baseline VAS scores were 8.60 ± 1.18 with corticosteroid injection and 8.47 ± 1.46 with high-intensity laser therapy (P=0.785). At one month, pain was significantly lower in the corticosteroid group (2.73 ± 1.66) than in the laser group (4.27 ± 1.16; P=0.007). At three months, the corresponding values were 1.73 ± 1.33 and 2.47 ± 1.06 (P=0.107). Repeated-measures analysis demonstrated a significant effect of time (P<0.001), a significant time-by-group interaction (P=0.003), and a significant group effect (P=0.006), indicating a faster early pain response with local corticosteroid injection.

Table 2. Mean pain intensity (VAS) before treatment and at one and three months in patients with De Quervain tenosynovitis, by treatment group.

Quality-of-life scores increased significantly over time in both groups (P<0.001), without a significant between-group difference over time (time-by-group P=0.276). In the corticosteroid and laser groups, SF-12 scores were 33.73 ± 6.27 and 32.80 ± 5.37 before treatment (P=0.665), 40.60 ± 5.73 and 37.80 ± 4.91 at one month (P=0.364), and 42.53 ± 4.99 and 39.73 ± 5.18 at three months (P=0.143). The full Results section also reported significantly greater satisfaction with local corticosteroid injection. Patient satisfaction scores were 3.47 ± 0.64 versus 2.93 ± 0.59 at one month (P=0.025) and 3.46 ± 0.65 versus 2.96 ± 0.51 at three months (P=0.025). Physician satisfaction was likewise higher with corticosteroid injection at one month (3.66 ± 0.62 vs 2.96 ± 0.59; P=0.003) and three months (3.73 ± 0.59 vs 2.93 ± 0.59; P=0.001).

Conclusion

Both local corticosteroid injection and high-intensity laser therapy were associated with reduced tendon thickness and pain and improved quality of life over the three-month follow-up. Tendon-thickness and quality-of-life trajectories did not show a significant advantage for either treatment, whereas local corticosteroid injection produced a greater reduction in pain at one month and higher patient and physician satisfaction. Overall, both interventions were effective options in this trial, with corticosteroid injection showing a faster early clinical response in pain. The small sample of 30 patients and the three-month follow-up period should be considered when interpreting the findings.

Keywords: Corticosteroid, De Quervain's Tenosynovitis, Laser Therapy

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