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Cavaleri R.1, Schabrun S.1, Te M.1, Chipchase L.1
1Western Sydney University, School of Science and Health, Sydney, Australia
Background: De Quervain's disease is a costly and disabling cumulative trauma disorder characterised by persistent pain and swelling over the radial styloid process. Hand therapy and corticosteroid injections are the most common treatment options for this condition. However, the role of hand therapy in de Quervain's disease has been neglected somewhat in the literature, with previous systematic reviews focusing upon the effectiveness of corticosteroid injections alone. As a result, corticosteroid injections have been cited as best practice in the treatment of de Quervain's disease, despite the fact that no systematic reviews have compared their effectiveness to a multimodal definition of hand therapy. The common clinical practice of combining hand therapy and corticosteroid injections has also never been compared to corticosteroid injections alone in terms of treatment success.
Purpose: To compare the effectiveness of corticosteroid injections with that of
i) hand therapy alone and
ii) a combination of hand therapy and corticosteroid injections in the treatment of de Quervain's disease.
i) hand therapy alone and
ii) a combination of hand therapy and corticosteroid injections in the treatment of de Quervain's disease.
Methods: Searches of the electronic databases AMED, CINAHL, CENTRAL, EMBASE, MEDLINE, OTseeker, PEDro, PsycINFO, PubMed, Scopus, and Web of Science were performed. Two reviewers independently performed data extraction and methodological quality assessments. Outcome measures included treatment success, pain and function. Treatment success required a negative Finkelsteins test, as well as a statistically significant reduction in pain compared to baseline.
Results: Following screening, six studies were included. Both corticosteroid injections and hand therapy improved pain and function from baseline, with no significant between-group differences being identified. Acupuncture (RR 1.18, 95% CI 0.82 to 1.70) and orthoses (RR 2.47, 95% CI 0.79 to 7.75), which were the main forms of hand therapy identified, were just as effective as corticosteroid injections in terms of treatment success. However, significantly more participants were treated successfully when a combination of hand therapy and corticosteroid injections were compared to i) hand therapy alone (RR 0.53, 95% CI 0.35 to 0.80) and ii) injections alone (RR 0.76, 95% CI 0.64 to 0.89).
Conclusion(s): This review found no difference between corticosteroid injections and hand therapy in the treatment of de Quervains disease when used in isolation. However, concurrent use of hand therapy modalities and corticosteroid injections revealed a cumulative treatment effect, significantly improving patient outcomes when compared to either intervention alone. A combination of hand therapy and corticosteroid injections is therefore more effective than either intervention alone in the treatment of de Quervains disease.
Implications: This review highlights the importance of hand therapy in the treatment of de Quervains disease, and provides clinicians with a number of effective treatment options. Apprehension about injections, or contraindications to corticosteroid administration, may render this intervention infeasible for some client groups. In such instances, clients can be reassured that hand therapy (in the form of orthoses and acupuncture) alone is effective, and similar to corticosteroid injections in terms of treatment success. Where possible, however, collaborative approaches are preferable, with a combination of hand therapy and corticosteroid injections yielding the best possible outcomes for this condition.
Funding acknowledgements: None.
Topic: Musculoskeletal: upper limb
Ethics approval: Ethical approval was not required for this systematic review.
All authors, affiliations and abstracts have been published as submitted.
