Impact of Ultrasound-Guided Corticosteroid Injections on Intervention-Free Survival for de Quervain's Tenosynovitis.

Abstract

De Quervain's tenosynovitis is a common cause of radial wrist pain, with corticosteroid injections providing excellent relief. Ultrasound guidance may improve anatomic accuracy and symptom resolution. This study investigates the benefits of ultrasound-guidance and its effects on reintervention-free survival time. Patients at a single academic institution between 2014 and 2025 with de Quervain's tenosynovitis receiving at least one corticosteroid injection were included. Patients undergoing traditional and ultrasound-guided injections were propensity score matched. Primary events were repeat injections or operative release. Time to primary event was analyzed with the Kaplan-Meier product-limit method. Cox proportional hazards regression discerned the impacts of ultrasound guidance while accounting for demographic characteristics and comorbidities. Ninety-nine hands received an ultrasound-guided corticosteroid injection, matched to 297 hands undergoing traditional injections. After a single ultrasound-guided injection, 77.8% of cases did not require further intervention; 22.2% of patients underwent reintervention at a median of 205.5 days. Estimated incidence of freedom from reintervention was 98% at six weeks, 95% at three months, and 85% at six months. A subgroup analysis excluding injections performed by fellowship-trained hand surgeons did not demonstrate benefits in reintervention rates with ultrasound guidance. Corticosteroid injections elicited excellent responses in patients. Ultrasound guidance was not associated with reduced intervention rates or longer times between reinterventions, even among injections administered by providers lacking formal hand surgery fellowship training. Both traditional and ultrasound-guided corticosteroid injections offer significant symptom relief and reduce the likelihood of further intervention.