FPIN's Help Desk Answers

Treatments for de Quervain Tenosynovitis

 

Am Fam Physician. 2018 Jun 15;97(12):online.

Clinical Question

Are corticosteroid injections better than conservative treatment in patients with de Quervain tenosynovitis?

Evidence-Based Answer

Corticosteroid injections are no better than thumb spica orthoses for decreasing pain in patients with de Quervain tenosynovitis. (Strength of Recommendation [SOR]: B, based on a meta-analysis of low-quality randomized controlled trials [RCTs].) When combined with orthoses, corticosteroid injections and acupuncture are equally effective for improving function and decreasing pain. (SOR: B, based on a low-quality RCT.)

Evidence Summary

A 2016 systematic review and meta-analysis of six RCTs (N = 334) compared the effectiveness of corticosteroid injection vs. thumb spica orthosis or a combination of the two treatments for the management of de Quervain tenosynovitis.1 Participants were diagnosed clinically using a positive Finkelstein or Eichhoff test. Corticosteroid injections consisted of methylprednisolone (five studies; 10 to 40 mg) and triamcinolone (one study, dose unknown). Three studies compared injections with orthoses, and three studies compared combined injections and orthoses with orthoses or injections alone. Treatment success was defined by a negative Finkelstein test and no pain (four studies), or a decrease in pain on a visual analog scale (two studies). After three to 26 weeks, orthoses alone had a lower rate of treatment success compared with combined injections and orthoses (two studies; N = 181; relative risk [RR] = 0.53; 95% confidence interval [CI], 0.35 to 0.80). At three weeks, corticosteroid injections alone had a lower rate of treatment success compared with combined injections and orthoses (two studies; N = 167; RR = 0.76; 95% CI, 0.64 to 0.89). Orthoses alone compared with corticosteroid injection alone had similar success rates at two to three weeks (three studies; N = 172; RR = 2.5; 95% CI, 0.79 to 7.8). Study limitations included lack of blinding or concealed allocation.

A 2013 nonblinded randomized study (N = 30)

Author disclosure: No relevant financial affiliations.

Address correspondence to Suzan Skef, MD, at skefs@upmc.edu. Reprints are not available from the authors.

References

1. Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: a systematic review and meta-analysis. J Hand Ther. 2016;29(1):3–11.

2. Hadianfard M, Ashraf A, Fakheri M, Nasiri A. Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis: a randomized controlled trial. J Acupunct Meridian Stud. 2014;7(3):115–121.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

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