Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis

Study design Systematic review with meta-analysis. Introduction Although corticosteroid injections are often cited as best practice in the treatment of de Quervain's disease, no reviews have compared their effectiveness to a multimodal definition of hand therapy. Purpose To compare the effectiveness of corticosteroid injections with that of i) hand therapy alone and ii) combined hand therapy/corticosteroid injection approaches in the treatment of de Quervain's disease. Methods Searches of key databases were performed to identify experimental studies published between January 1950 and November 2014. Outcome measures included treatment success, pain, quality of life, and function. Results Both corticosteroid injections and hand therapy improved pain and function from baseline, but between-group differences were not significant (across 6 studies). However, significantly more participants were treated successfully when combined orthosis/corticosteroid injection approaches were compared to i) orthoses (RR 0.53, 95% CI 0.35–0.80) and ii) injections alone (RR 0.76, 95% CI 0.64–0.89). Conclusion Combined orthosis/corticosteroid injection approaches are more effective than either intervention alone in the treatment of de Quervain's disease. Level of evidence 1a.