RESEARCH ARTICLE


The Effectiveness of Corticosteroid Injection for De Quervain’s Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis



Patrick Rowland 1, Nigel Phelan 1, Sean Gardiner 1, Kenneth N Linton*, 1, 2, Rose Galvin 3
1 Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
2 Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
3 HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland


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© Rowland et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Trauma and Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland; Tel: +353-86-407-6779; E-mail: kennethlinton@rcsi.ie


Abstract

De Quervain’s stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group.

Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.

Keywords: De Quervain, corticosteroid injection, meta-analysis, stenosing tenosynovitis, review, systematic.