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THU0214 Effect of triamcinolone diacetate injections in early dupuytren’s contracture and stenosing tenosynovitis of the hand
  1. B Mukerji
  1. Internal Medicine, SIU School of Medicine, Springfield, USA

Abstract

Background Dupuytren’s contracture and other fibrosing conditions of the hand are generally progressive, causing limitation of function and decreasing grip strength. Long term results of surgical procedures are less than optimal with high recurrence and extension rates. Other non-operative therapies such as slow skeletal traction, radiation, splinting, ultrasound and enzymatic fasciotomy have not proven to be clinically useful.

Objectives The objective of this study was to determine the effectiveness of steroid injections in slowing the progression of fibrosis and contractures in early Dupuytren’s disease and conditions causing stenosing tenosynovitis of the hand.

Methods Twenty-three patients were studied. There were 12 men and 11 women with an age range of 35 to 72 years. Of these patients four also had diabetes mellitus and three had rheumatoid arthritis. Eighteen patients had Dupuytrens’ contracture. Fifteen had bilateral contractures and three in one hand only. None of them had contractures in the proximal interphalangeal joints. One had mild flexion contracture at the second, third and fourth metacarpophalangeal joints. Two had bilateral De Quervain’s tenosynovitis and three had isolated fibrous nodules in one flexor tendon in the hand. All patients received one or two triamcinolone diacetate injections in the fibrous nodules, cords and tendon sheaths. Additionally, five patients received oral non-steroidal antiinflammatory agents for one to two weeks. Patients with Dupuytren’s contracture demonstrated softening of the symptomatic chords, improvement of grip strength and partial resolution of nodules. The other patients had complete resolution of their condition.

Results Patients were followed for one to seven years and maintained their functional improvement. No patient’s contracture progressed or required surgery or radiotherapy. There were no complications such as hematoma, skin necrosis, infection, granuloma formation, decrease in grip strength, transient paresthesia or flexion deformity of the fingers.

Conclusion In conclusion, early Dupuytren’s disease and other fibrosing tenosynovitis of the hands can be safely and effectively treated with injections of triamcinolone diacetate and this appears to prevent progression of these conditions.

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