Corticosteroid injection for de Quervain's tenosynovitis

  • Review
  • Intervention

Authors

  • Cyriac Peters-Veluthamaningal,

    Corresponding author
    1. University Medical Center Groningen, Department of General Practice, Groningen, Netherlands
    • Cyriac Peters-Veluthamaningal, Department of General Practice, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, Netherlands. raju@dds.nl.

    Search for more papers by this author
  • Daniëlle AWM van der Windt,

    1. VU University Medical Centre, EMGO Institute and Department of General Practice, Amsterdam, Netherlands
    Search for more papers by this author
  • Jan C Winters,

    1. University Medical Center Groningen, Department of General Practice, Groningen, Netherlands
    Search for more papers by this author
  • Betty Meyboom-de Jong

    1. University Medical Center Groningen, Department of General Practice, Groningen, Netherlands
    Search for more papers by this author

Abstract

Background

De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery.

Objectives

To summarise evidence on the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis.

Search methods

We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to April 2009), EMBASE (1956 to April 2009), CINAHL (1982 to April 2009), AMED (1985 to April 2009), DARE, Dissertation Abstracts and PEDro (physiotherapy evidence database).

Selection criteria

Randomised and controlled clinical trials evaluating the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis.

Data collection and analysis

After screening abstracts of studies identified by the search we obtained full text articles of studies which fulfilled the selection criteria. We extracted data using a predefined electronic form. We assessed the methodological quality of included trials by using the checklist developed by Jadad and the Delphi list. We extracted data on the primary outcome measures: treatment success; severity of pain or tenderness at the radial styloid; functional impairment of the wrist or hand; and outcome of Finkelstein's test, and the secondary outcome measures: proportion of patients with side effects; type of side effects and patient satisfaction with injection treatment.

Main results

We found one controlled clinical trial of 18 participants (all pregnant or lactating women) that compared one steroid injection with methylprednisolone and bupivacaine to splinting with a thumb spica. All patients in the steroid injection group (9/9) achieved complete relief of pain whereas none of the patients in the thumb spica group (0/9) had complete relief of pain, one to six days after intervention (number needed to treat to benefit (NNTB) = 1, 95% confidence interval (CI) 0.8 to 1.2). No side effects or local complications of steroid injection were noted.

Authors' conclusions

The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in only one small controlled clinical trial, which found steroid injections to be superior to thumb spica splinting. However, the applicability of our findings to daily clinical practice is limited, as they are based on only one trial with a small number of included participants, the methodological quality was poor and only pregnant and lactating women participated in the study. No adverse effects were observed.

摘要

背景

類固醇注射治療de Quervain's腱鞘炎

De Quervain's腱鞘炎是手腕橈側疼痛及功能失能疾患,de Quervain's腱鞘炎可用類固醇注射、護木、或手術治療。

目標

研究類固醇注射治療de Quervain's腱鞘炎的效果及安全性。

搜尋策略

搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to April 2009) MBASE (1956 to April 2009), CINAHL (1982 to April 2009), AMED (1985 to Apri 009), DARE, Dissertation Abstracts and PEDro (physiotherapy evidence database)。

選擇標準

隨機及對照試驗研究評估類固醇注射治療de Quervain's腱鞘炎的效果及安全性。

資料收集與分析

兩位作者進行資料摘錄於先設定之電子格式中,並對每篇試驗研究的品質進行評估(checklist developed by Jadad and the Delphi list)。主要測量指標為:治療成功、在radial styloid的疼痛嚴重度、腕或手功能失能、Finkelstein's test結果。次要指標為:副作用病患百分比、病患滿意度。

主要結論

發現1篇研究包含18例病患﹝皆懷孕或哺乳﹞於分析中,比較注射一次methylprednisolone與bupivacaine比上手腕手指護具,注射後1到6天,所有類固醇注射治療的患者疼痛完全改善(9/9),而手腕手指矯具組無人疼痛完全改善(0/9),NNTB = 1, 95% CI 0.8 to 1.2),類固醇注射並未出現副作用。

作者結論

類固醇注射治療de Quervain's腱鞘炎的效果僅發現1篇小型控制研究,類固醇注射治療比手腕手指矯具效果好,但樣本數太少,方法品質不佳,且僅包括懷孕或哺乳婦女。未出現副作用。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

此Cochrane回顧摘要了我們所知道有關注射皮質類固醇對de Quervain腱鞘炎治療的效果。這項審查表明,在de Quervain腱鞘炎患者,我們不能確定是否注射皮質類固醇可以減少疼痛,是因為只有非常低品質的證據。什麼是de Quervain腱鞘炎和皮質類固醇注射是什麼?de Quervain腱鞘炎發生在你的拇指和手腕發炎時,會疼痛和困難移動。肌腱是你的身體的一部分,連接你的肌肉到骨骼。de Quervain腱鞘炎患者在拇指基部疼痛,壓痛,腫脹,尤其是當他們的手腕從撓側移動至尺側或從尺側移動至撓側。皮質類固醇注射是用針注射到關節(如您的手腕)或肌腱。皮質類固醇可能透過降低您的手腕或拇指發炎來發揮作用。該注射本身也可能有助於減輕肌腱壓力

Plain language summary

Corticosteroid injection for de Quervain's tenosynovitis

This summary of a Cochrane review presents what we know from research about the effect of Corticosteroid injections for de Quervain's tenosynovitis.

This review shows that in people with de Quervain's tenosynovitis,

We are uncertain whether Corticosteroid injections reduces pain because of the very low quality of the evidence.

What is de Quervain's tenosynovitis and what are corticosteroid injections?

De Quervain's tenosynovitis occurs when the tendon in your thumb and wrist becomes inflammed, painful and difficult to move.  A tendon is the part of your body that connects your muscles to your bones.  People with de Quervain's tenosynovitis have pain, tenderness, and swelling at the base of the thumb, especially when moving their wrist from side to side.   

Corticosteroid injections are shots with a needle into a joint (such as your wrist) or a tendon. Corticosteroids may work by reducing the inflammation of your wrist or thumb. The injection itself might also help to relieve the pressure on the tendon.

Ancillary