De Quervain's Tenosynovitis causes pain and dysfunction of the wrist and thumb due to the thickening of the first dorsal compartment, housing the abductor pollicis longus and extensor pollicis brevis tendons. Traditional treatment includes corticosteroid injections, braces, physiotherapy, and surgical release. Hyaluronic acid, known for its lubricating properties, may offer a non-surgical alternative by improving gliding at the tendon-retinaculum interface. To measure the effect of hyaluronic acid on tendon gliding in the 1st dorsal compartment compared to saline and corticosteroids. Eighteen cadaveric specimens of the 1st extensor tendon compartment were tested to assess friction between the abductor pollicis longus and extensor pollicis brevis against the extensor retinaculum using a validated biomechanical model. Specimens were initially soaked in saline; nine were subsequently treated with hyaluronic acid, and nine with Celestone Soluspan. Friction testing was conducted at both 30°–20° and 30°–0° angles to simulate various wrist-thumb positions. Hyaluronic acid significantly reduced the average friction between the tendons of the first dorsal compartment and retinaculum by 18.7% compared to saline (p < 0 .05), with the most significant reduction observed in the extensor pollicis brevis at the 30°–20° angle (28.2%). In contrast, corticosteroids did not achieve a statistically significant reduction in friction compared to saline. This biomechanical study demonstrates that hyaluronic acid significantly reduces friction in the 1st extensor compartment, enhancing tendon gliding, particularly in the extensor pollicis brevis. The specific benefit of hyaluronic acid on the extensor pollicis brevis suggests a potential for targeted, ultrasound-guided hyaluronic acid injections. Furthermore, the significant friction reduction at the 30°–20° angle might support the use of a brace in this certain position after the injection. These lab results suggest that hyaluronic acid might be a non-surgical therapeutic alternative for De Quervain's Tenosynovitis, meriting further clinical investigation.
Rotem et al. (Wed,) studied this question.