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. 2023 Oct 2;6(10):e2337001.
doi: 10.1001/jamanetworkopen.2023.37001.

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Dimitris Challoumas  1 , Rohan Ramasubbu  1 , Elliot Rooney  1 , Emily Seymour-Jackson  1 , Amit Putti  2 , Neal L Millar  1
Affiliations

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Dimitris Challoumas et al. JAMA Netw Open. .

Abstract

Importance: There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.

Objective: To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.

Study selection: All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.

Data extraction and synthesis: This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.

Main outcomes and measures: Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.

Results: A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.

Conclusions and relevance: This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flowchart of Study Selection Process
Figure 2.
Figure 2.. Results of Pairwise Meta-Analysis of Function Outcomes of Corticosteroid Injection (CSI) Plus Thumb Spica Immobilization vs CSI Alone
Function outcomes were assessed using the quick disabilities of the arm, shoulder, and hand scale (range, 0-80; higher score indicates worse function). Short-term outcomes were defined as 0 to 12 weeks; mid-term, 13 weeks to 12 months. Each square represents the point estimate of the result of that study; size of square is proportional to the contribution of the study to the overall result, dependent on the population size and SD. Whiskers indicate 95% CIs. The diamond represents the combined point estimate and 95% CI.
Figure 3.
Figure 3.. Effectiveness of Interventions for de Quervain Tenosynovitis for Short-Term Pain
Short-term was defined as 0 to 12 weeks. A, Diameter of the circle represents the number of studies assessing that intervention; thickness of the line, number of studies assessing that comparison of interventions. CSI indicates conventional corticosteroid injection; EPB, extensor pollicis brevis; ESWT, extracorporeal shockwave therapy; US, ultrasonography.
Figure 4.
Figure 4.. Suggested Treatment Algorithm for de Quervain Tenosynovitis (DQT)
CSI indicates conventional corticosteroid; MRI, magnetic resonance imaging; US, ultrasonography.
See this image and copyright information in PMC

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