Local steroid injection and thumb spica immobilization effective first line treatment of wrist DQTS: study

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.

Key findings of the study were:

• 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 metaanalyses, 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.

The authors concluded - “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 DQTS.”

Further reading:

Management of de Quervain Tenosynovitis A Systematic Review and Network Meta-Analysis Dimitris Challoumas et al JAMA Network Open. 2023;6(10):e2337001 doi:10.1001/jamanetworkopen.2023.37001