Evaluates the efficacy of ultrasound guided versus clinically guided steroid injection in the management of tenosynovitis in DM patients.

The current study will based on follow up study, conducted among patients presenting at outpatient rheumatology clinics of Al-Azhar University Hospitals, Egypt. with Diabetes mellitus duration at least 3 years and tenosynovitis of hand tendons with Richie tenderness grade 3.

All patients will randomized in two groups: Group one: 26 patients DM patients with tenosynovitis were injected by triamcinolone under ultrasound guidance. Group two: 26 patients DM patients with tenosynovitis were injected by triamcinolone under clinical guidance.

The affected tendons will scanned and scored for inflammation using ultrasound in all patients before the triamcinolone injection and then to be reassessed one month after the injection to determine the change in the tendons in both groups.

Inclusion Criteria:

• • Diabetes mellitus.

  • Disease duration 3 years or more.
  • Tenosynovitis of hand tendons with Richie tenderness grade 3.

Exclusion Criteria:

• • Patients with recent hand trauma.

  • Patients with inflammatory hand arthritis.
  • Previous tendon surgery.
  • Previous tendon injection.
  • Patients with contraindication for injection as related infection, uncontrolled DM or bleeding tendency.