Local steroid injection with thumb spica immobilization first-line treatment for de Quervain Tenosynovitis

A recent network meta-analysis provides valuable insights into the management of de Quervain tenosynovitis (DQT), a painful condition affecting the wrist and thumb tendons. With a plethora of treatment options available for patients with DQT, this study aimed to assess and compare the effectiveness of these treatments, offering guidance for musculoskeletal practitioners and healthcare guidelines.

This study was published in JAMA Network Open by Dimitris C. and colleagues. DQT is a condition characterized by wrist and thumb tendon inflammation, causing pain and discomfort. However, there are limited data on the effectiveness of various treatment options for DQT, leading to a lack of definitive management guidelines. To address this gap, researchers conducted a systematic review of available randomized clinical trials to assess the efficacy of DQT interventions.

The study, which included 30 trials with 1663 patients, revealed important findings:

• Adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically significant improvements in short-term and mid-term functional outcomes. However, these improvements, while statistically significant, were not considered clinically significant.
• Network meta-analysis ranked interventions that included ultrasonography-guided CSI as most effective for pain relief.
  
• CSI combined with thumb spica immobilization emerged as the most effective treatment for short- and mid-term function.
  

The study's findings suggest that the administration of corticosteroid injections followed by a short period of thumb spica immobilization should be considered as a first-line treatment for patients with DQT. This combination of treatments showed statistically significant benefits in terms of function, although the clinical significance of these benefits may be limited.

This network meta-analysis offers musculoskeletal practitioners and healthcare professionals valuable insights into the management of de Quervain tenosynovitis. While no single treatment may provide a complete cure, the combination of corticosteroid injections and thumb spica immobilization appears to be the most effective approach in improving function for patients with DQT. By informing clinical decision-making, these findings contribute to enhancing the quality of life for individuals affected by this painful condition.

Reference:

Challoumas, D., Ramasubbu, R., Rooney, E., Seymour-Jackson, E., Putti, A., & Millar, N. L. Management of de Quervain tenosynovitis: A systematic review and network meta-analysis. JAMA Network Open,2023;6(10):e2337001. https://doi.org/10.1001/jamanetworkopen.2023.37001