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Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis.

Han Hong Chong1, Akhilesh Pradhan1, Mohit Dhingra1

  • 1Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom.

The Journal of Hand Surgery
|April 13, 2024
PubMed
Summary

Corticosteroid injections remain the primary treatment for de Quervain tenosynovitis, offering effective pain relief. Extracorporeal shockwave therapy is a viable secondary option for managing this condition.

Keywords:
Comparative effectivenessDQTde Quervain’snetwork meta-analysisoutcome

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Area of Science:

  • Orthopedics and Sports Medicine
  • Rheumatology
  • Physical Therapy

Background:

  • De Quervain tenosynovitis is a common condition causing wrist pain and functional limitation.
  • Nonsurgical treatments are widely used, but comparative effectiveness data are limited.

Purpose of the Study:

  • To conduct a network meta-analysis evaluating the comparative effectiveness of nonsurgical treatment modalities for de Quervain tenosynovitis.
  • To identify optimal nonsurgical interventions based on short-term, medium-term, and long-term outcomes.

Main Methods:

  • Systematic review and network meta-analysis adhering to PRISMA guidelines.
  • Inclusion of 14 randomized controlled trials (RCTs).
  • Categorization of outcomes by follow-up duration: short-term (≤6 weeks), medium-term (6 weeks–6 months), and long-term (1 year).

Main Results:

  • Extracorporeal shockwave therapy (ESWT) showed significant short-term pain reduction compared to placebo.
  • In the short-term, ESWT ranked highest, followed by corticosteroid injections (CSIs) with casting and laser therapy with orthosis.
  • Long-term findings indicated sustained pain relief with CSI alone and platelet-rich plasma (PRP) injections; CSI with orthosis also showed promise.

Conclusions:

  • Corticosteroid injection with short-term immobilization is the primary effective treatment for de Quervain tenosynovitis.
  • Extracorporeal shockwave therapy is a recommended secondary treatment option.
  • Isolated therapeutic injections should be used cautiously due to limited evidence of substantial benefit over placebo.