Systematic review and meta-analysis on steroid injection therapy for de Quervain’s tenosynovitis in adults

  • Muhammad Omer Ashraf
  • V. G. Devadoss
General Review



de Quervain’s tenosynovitis is a painful condition of the wrist which leads to difficulties in performing activities of daily living.


This systematic review was conducted to examine the effectiveness of steroid injection therapy as compared to splinting for treatment of de Quervain’s tenosynovitis in adults.


The following databases were searched for relevant studies, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO (via NHS Evidence), and Cochrane Library (via Cochrane Collaboration). Synonyms and free texts were used to locate studies. The reference lists of articles were checked for related papers. Hand searching was performed for important relevant journals. All searches found 89 studies, out of which 14 were relevant. Two studies were selected according to the inclusion criteria of the systematic review. Data were extracted and analysed for the two selected randomised trials using a fixed effect model at 95 % confidence intervals.


The meta-analysis demonstrated that the total effect estimate was 3 with a narrow 95 % confidence interval (1.89, 4.77). z score for overall effect was 4.66 which was highly significant (p < 0.01). Moderate heterogeneity with I-square test was found to be 64 % but was not significant (p > 0.05). Number needed to treat was 2, which showed that for every two persons treated with steroid injections, one person gets the benefit.


Steroid injection is an effective form of conservative management for de Quervain’s disease although more research is needed to establish the full benefits of the treatment.


de Quervain’s disease Tenosynovitis Steroid injections Systematic review 


Conflict of interest

Each author certifies that he has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.


  1. 1.
    Ilyas AM, Ast M, Schaffer AA (2007) De-Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg 15:757–764PubMedGoogle Scholar
  2. 2.
    Schned ES (1986) De Quervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol 68:411–894PubMedCrossRefGoogle Scholar
  3. 3.
    Batteson R, Hammond A, Burke F (2008) The de Quervain’s screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care 6:168–180PubMedCrossRefGoogle Scholar
  4. 4.
    Weiss AP, Akelman E, Tabatabai M (1994) Treatment of de Quervain’s disease. J Hand Surg Am 19:595–598PubMedCrossRefGoogle Scholar
  5. 5.
    de Quervain F (1895) Uerber eine form von chronisher tendovaginitis. Cor-Br F Schweiz aerzte 4:899–903Google Scholar
  6. 6.
    Finkelstein H (1930) Stenosing tendovaginitis at the radial styloid process. J Bone Joint Surg 12:509–540Google Scholar
  7. 7.
    Patterson DC (1936) De Quervain’s disease: stenosing tenovaginitis at the radial styloid. N Engl J Med 214:101–102CrossRefGoogle Scholar
  8. 8.
    Keon-Cohen B (1951) De Quervain’s disease. J Bone Joint Surg 33B:96–99Google Scholar
  9. 9.
    Wright PE (2008) Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In: Campbell WC, Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 11th edn. Mosby/Elsevier, Philadelphia, PA, pp 4299–4230Google Scholar
  10. 10.
    Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C (2004) Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 51:642–651PubMedCrossRefGoogle Scholar
  11. 11.
    Ranney D, Wells R, Moore A (1995) Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings. Ergonomics 38(7):1408–1423PubMedCrossRefGoogle Scholar
  12. 12.
    Avci S, Yilmaz C, Sayli U (2002) Comparison of nonsurgical treatment measures for de Quervain’s disease of pregnancy and lactation. J Hand Surg Am 27:322–324PubMedCrossRefGoogle Scholar
  13. 13.
    Valen PA, Foxworth J (2010) Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions. Curr Opin Rheumatol 22(2):194–204PubMedCrossRefGoogle Scholar
  14. 14.
    Mehdinasab SA, Alemohammad SA (2010) Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain’s tenosynovitis. Arch Iran Med 13(4):270–274PubMedGoogle Scholar
  15. 15.
    Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom-de Jong B (2009) Corticosteroid injection for de Quervain’s tenosynovitis. Cochrane Database Syst Rev (3). Accessed 11 Dec 2011
  16. 16.
    Moore JS (1997) De Quervain’s tenosynovitis: stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med 39(10):990–1002PubMedCrossRefGoogle Scholar
  17. 17.
    Crop JA, Bunt CW (2011) Doctor, my thumb hurts. J Fam Pract 60(6):329–332PubMedGoogle Scholar
  18. 18.
    Ta KT, Eidelman D, Thomson JG (1999) Patient satisfaction and outcomes of surgery for de Quervain’s tenosynovitis. J Hand Surg 24A(5):1071–1077CrossRefGoogle Scholar
  19. 19.
    Witt J, Pess G, Gelberman RH (1991) Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am 73(2):219–222PubMedGoogle Scholar
  20. 20.
    McKenzie JM (1972) Conservative treatment of de Quervain’s disease. Br Med J 4:659–660PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Anderson BC, Manthey R, Brouns MC (1991) Treatment of De Quervain’s tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum 34:793–798PubMedCrossRefGoogle Scholar
  22. 22.
    Zingas C, Failla JM, Van Holsbeeck M (1998) Injection accuracy and clinical relief of de Quervain’s tendinitis. J Hand Surg Am 23(1):89–96PubMedCrossRefGoogle Scholar
  23. 23.
    Christie BGB (1955) Local hydrocortisone in de Quervain’s disease. Br Med J 1(4929):1501–1503PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Lane LB, Boretz RS, Stuchin SA (2001) Treatment of de Quervain’s disease: role of conservative management. J Hand Surg Br 26(3):258–260PubMedCrossRefGoogle Scholar
  25. 25.
    Harvey FJ, Harvey PM, Horsley MW (1990) De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg Am 15:83–87PubMedCrossRefGoogle Scholar
  26. 26.
    Richie CA, Briner WW (2003) Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract 16(2):102–106PubMedCrossRefGoogle Scholar
  27. 27.
    Katz S (1983) Assessing selfmaintenance: activities of daily living, mobility and instrumental activities of daily living. JAGS 31(12):721–726Google Scholar
  28. 28.
    McDowell I, Newell C (1996) Measuring health: a guide to rating scales and questionnaires, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  29. 29.
    CRD (2009) Systematic reviews: CRD guidance for undertaking reviews in healthcare.!SSL!/WebHelp/SysRev3.htm. Accessed 11 Dec 2011
  30. 30.
    Khan K, Kunz R, Kleijnen J, Antes G (2009) Systematic reviews to support evidence based medicine. How to review and apply findings of healthcare research. Royal Society of Press, Ltd, London, pp 27–33Google Scholar
  31. 31.
    OpenGrey (2011) Accessed 14 Dec 2011
  32. 32.
    Current Controlled Trials (2011) Current controlled trials. Accessed 11 Dec 2011
  33. 33.
    Glasziou P (2001) Systematic reviews in health care : a practical guide. Cambridge University Press, Port Chester, NY, pp 66-67. Accessed 11 Dec 2011
  34. 34.
    PRISMA. (2009) Accessed 23 Dec 2011
  35. 35.
    RefWorks. (2009) RefWorks—an online research management, writing and collaboration tool. Accessed 13 Dec 2011
  36. 36.
    Berlin JA (1997) Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet 350(9072):185–186PubMedCrossRefGoogle Scholar
  37. 37.
    Higgins JPT, Deeks JJ (2008) Chapter 7: selecting studies and collecting data. In: Higgins JPT, Green S (eds) Cochrane Handbook of systematic reviews of intervention (Version 5.0.1). Accessed 11 Dec 2011
  38. 38.
    Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B (2009) Randomised controlled trial of local corticosteroid injections for de Quervain’s tenosynovitis in general practice. BMC Musculoskelet Disord 10:131Google Scholar
  39. 39.
    Kosuwon J (1996) Treatment of de Quervain tenosynovitis: a prospective randomized controlled study comparing the results of steroid injection with and without immobilization in a splint. J Clin Epidemiol 1(1):5SCrossRefGoogle Scholar
  40. 40.
    Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S (2004) Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg 86-A(12):2700–2706Google Scholar
  41. 41.
    Goldfarb CA, Gelberman RH, McKeon K, Chia B, Boyer MI (2007) Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg 32(10):1513–1520CrossRefGoogle Scholar
  42. 42.
    Furlan AD, Pennick, V., Bombardier, C. & van Tulder, M. (2009) Editorial Board, Cochrane Back Review Group. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 34(18):1929–1941Google Scholar
  43. 43.
    Huisstede BM, van Middelkoop M, Randsdorp MS, Glerum S, Koes BW (2010) Effectiveness of interventions of specific complaints of the arm, neck, and/or shoulder: 3 musculoskeletal disorders of the hand. An update. Arch Phys Med Rehabil 91(2):298–314Google Scholar
  44. 44.
    Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbe KA (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol 45(3):255–265PubMedCrossRefGoogle Scholar
  45. 45.
    RevMan (2011) Review manager. Version 5.1. The Nordic Cochrane Centre, The Cochrane Collaboration, CopenhagenGoogle Scholar
  46. 46.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.The Royal Oldham HospitalOldhamUK
  2. 2.Rochdale InfirmaryRochdaleUK

Personalised recommendations