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Tetik Parmak Tedavisinde Ortezle Kombine Edilen Ultrason RehberliÄŸinde Lokal Kortikosteroid Enjeksiyonu EtkinliÄŸi: Randomize Kontrollü Çalışma
The Effectiveness of Ultrasound Guided Local Corticosteroid Injection Combined with Orthosis in the Treatment of Trigger Digit: A Randomized Controlled Study
Received Date : 09 Apr 2022
Accepted Date : 03 Jan 2023
Available Online : 09 Jan 2023
Doi: 10.31609/jpmrs.2022-90423 - Makale Dili: EN
J PMR Sci. 2023;26(2):125-32
ÖZET
Amaç: Bu çalışmanın amacı, tetik parmak tedavisinde ultrason rehberliğinde lokal kortikosteroid enjeksiyonu etkinliğini araştırmaktır. Gereç ve Yöntemler: Prospektif randomize kontrollü klinik bu çalışmaya Wolfe evrelemesine göre Evre 2 ve/veya Evre 3 tetik parmağı olan 18 yaş üstü 43 hasta dâhil edildi. Bütün hastalar sağ el dominanttı. Hastalar randomize olarak ortez grubuna ve ya kombine tedavi grubuna (kortikosteroid enjeksiyonu+ ortez) ayrıldı. Birinci grup hastalar metakarpofalangeal, proksimal interfalangeal ve distal interfalangeal eklemleri 0 derece ekstansiyonda tutan ortez kullanımı ile tedavi edildiler. İkinci grup hastalar ortez kullanımına ilave ultrason rehberli kortikosteroid enjeksiyonu ile tedavi edildiler. Değerlendirmeler tedavi öncesi ve tedaviden 6 hafta sonra yapıldı. Ağrı seviyesi ve tetiklenme seviyesi görsel analog skala [visual analogue scale (VAS)] ile değerlendirildi. El becerisi Nine Hole Peg Test ile el kavrama gücü hidrolik el dinamometresi ile üst ekstremite aktiviteleri ve fonksiyonelliği Kol, Omuz ve El sorunları Anketi [Disabilities of the Arm, Shoulder and Hand (DASH)] ile değerlendirildi. Bulgular: Kombine tedavi grubunda bütün klinik değişkenlerde istatistiksel olarak anlamlı iyileşme izlenirken, ortez grubunda sadece VAS (ağrı ve tetiklenme) ve DASH skorlarında istatistiksel olarak anlamlı değişiklik saptandı. Her iki grup karşılaştırıldığında kombine tedavi grubundaki VAS (ağrı ve tetiklenme) ve DASH skorlarındaki iyileşme daha fazla idi. Sonuç: Tetik parmak tedavisinde ortez kullanımı ile kortikosteroid enjeksiyonunun kombine edilmesi tek başına ortez kullanımından daha etkili görünüyor.
ABSTRACT
Objective: The aim of this study was to investigate the effectiveness of ultrasound guided local corticosteroid injection in the treatment of trigger digit. Material and Methods: 43 patients over 18 years with a Wolfe Grade 2 and/or 3 trigger digit were enrolled in this prospective randomized controlled clinical study. All patients were right handed. Patients were randomly assigned to orthosis group or combined treatment group (corticosteroid injection+orthosis use). The first group patients were treated by using an orthosis of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joint at 0 degrees of extension. Second group patients were treated by ultrasound guided corticosteroid injection in addition to the orthosis use. Evaluation was done at baseline and at 6 weeks posttreatments. Pain level and triggering level were assessed by visual analogue scale (VAS). Dexterity was assessed by the Nine Hole Peg Test, hand grip strength was assessed by the hydraulic hand dynamometer, upper extremity activities and functionality were assessed by the Disabilities of the Arm Shoulder and Hand (DASH) Questionnaire. Results: Combined treatment group showed significant improvements in all clinical variables, but orthosis group showed significant improvements only in terms of VAS pain, VAS triggering and DASH scores. The reduction in VAS pain, VAS triggering and DASH scores was significantly greater in combined treatment group. Conclusion: Combining corticosteroid injection to orthosis use seems to be more effective in trigger digit compared to orthosis use alone.
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