Review article (meta-analysis)| Volume 99, ISSUE 8, P1635-1649.e21, August 2018

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Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review

Published:August 28, 2017DOI:



      To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.

      Data Sources

      Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).

      Data Selection

      Two reviewers independently applied the inclusion criteria to select potential studies.

      Data Extraction

      Two reviewers independently extracted the data and assessed the methodologic quality.

      Data Synthesis

      A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.


      In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.


      List of abbreviations:

      CANS (complaints of the arm, neck, and/or shoulder), CI (confidence interval), DASH-Q (Disability of the Arm, Shoulder and Hand Questionnaire), MCP (metacarpophalangeal), PEDro (Physiotherapy Evidence Database), PIP (proximal interphalangeal), PNA (percutaneous needle aponeurotomy), RCT (randomized controlled trial), TA (triamcinolone acetonide), VAS (visual analog scale)
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        • Huisstede B.M.
        • Miedema H.S.
        • Verhagen A.P.
        • Koes B.W.
        • Verhaar J.A.
        Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder.
        Occup Environ Med. 2007; 64: 313-319
        • Huisstede B.M.
        • Wijnhoven H.A.
        • Bierma-Zeinstra S.M.
        • Koes B.W.
        • Verhaar J.A.
        • Picavet S.
        Prevalence and characteristics of complaints of the arm, neck, and/or shoulder (CANS) in the open population.
        Clin J Pain. 2008; 24: 253-259
        • Huisstede B.M.
        • Hoogvliet P.
        • Coert J.H.
        • Fridén J.
        • European HANDGUIDE Group
        Multidisciplinary consensus guideline for managing trigger finger: results from the European HANDGUIDE Study.
        Phys Ther. 2014; 94: 1421-1433
        • Huisstede B.M.
        • Hoogvliet P.
        • Coert J.H.
        • Fridén J.
        • European HANDGUIDE Group
        Dupuytren disease: European hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the HANDGUIDE study.
        Plast Reconstr Surg. 2013; 132: 964e-976e
        • Huisstede B.M.
        • Coert J.H.
        • Fridén J.
        • Hoogvliet P.
        • European HANDGUIDE Group
        Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study.
        Phys Ther. 2014; 94: 1095-1110
        • van Middelkoop M.
        • Huisstede B.M.
        • Glerum S.
        • Koes B.W.
        Effectiveness of interventions of specific complaints of the arm, neck, or shoulder (CANS): musculoskeletal disorders of the hand.
        Clin J Pain. 2009; 25: 537-552
        • Huisstede B.M.
        • van Middelkoop M.
        • Randsdorp M.S.
        • Glerum S.
        • Koes B.W.
        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. 2010; 91: 298-314
        • Furlan A.D.
        • Pennick V.
        • Bombardier C.
        • van Tulder M.
        • Editorial Board, Cochrane Back Review Group
        2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.
        Spine (Phila Pa 1976). 2009; 34: 1929-1941
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • et al.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary?.
        Control Clin Trials. 1996; 17: 1-12
        • Verhagen A.P.
        • de Vet H.C.
        • de Bie R.A.
        • et al.
        The Delphi List.
        J Clin Epidemiol. 1998; 51: 1235-1241
        • Peters-Veluthamaningal C.
        • Winters J.C.
        • Groenier K.H.
        • Jong B.M.
        Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomised placebo controlled trial.
        Ann Rheum Dis. 2008; 67: 1262-1266
        • Taras J.S.
        • Raphael J.S.
        • Pan W.T.
        • Movagharnia F.
        • Sotereanos D.G.
        Corticosteroid injections for trigger digits: is intrasheath injection necessary?.
        J Hand Surg Am. 1998; 23: 717-722
        • Gilberts E.C.
        • Beekman W.H.
        • Stevens H.J.
        • Wereldsma J.C.
        Prospective randomized trial of open versus percutaneous surgery for trigger digits.
        J Hand Surg Am. 2001; 26: 497-500
        • Ring D.
        • Lozano-Calderón S.
        • Shin R.
        • Bastian P.
        • Mudgal C.
        • Jupiter J.
        A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger.
        J Hand Surg Am. 2008; 33: 516-522
        • Topper S.M.
        • Jones D.E.
        • Klajnbart J.O.
        • Friedel S.P.
        Trigger finger: the effect of partial release of the first annular pulley on triggering.
        Am J Orthop (Belle Mead NJ). 1997; 26: 675-677
        • Callegari L.
        • Spanò E.
        • Bini A.
        • Valli F.
        • Genovese E.
        • Fugazzola C.
        Ultrasound-guided injection of a corticosteroid and hyaluronic acid: a potential new approach to the treatment of trigger finger.
        Drugs R D. 2011; 11: 137-145
        • Dierks U.
        • Hoffmann R.
        • Meek M.F.
        Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial.
        Tech Hand Up Extrem Surg. 2008; 12: 183-187
        • Bamroongshawgasame T.
        A comparison of open and percutaneous pulley release in trigger digits.
        J Med Assoc Thai. 2010; 93: 199-204
        • Peters-Veluthamaningal C.
        • van der Windt D.A.
        • Winters J.C.
        • Meyboom-de Jong B.
        Corticosteroid injection for trigger finger in adults.
        Cochrane Database Syst Rev. 2009; : CD005617
        • Peters-Veluthamaningal C.
        • van der Windt D.A.
        • Winters J.C.
        • Meyboom-de Jong B.
        Corticosteroid injection for de Quervain's tenosynovitis.
        Cochrane Database Syst Rev. 2009; : CD005616
        • Murphy D.
        • Failla J.M.
        • Koniuch M.P.
        Steroid versus placebo injection for trigger finger.
        J Hand Surg Am. 1995; 20: 628-631
        • Lambert M.A.
        • Morton R.J.
        • Sloan J.P.
        Controlled study of the use of local steroid injection in the treatment of trigger finger and thumb.
        J Hand Surg Br. 1992; 17: 69-70
        • Avci S.
        • Yilmaz C.
        • Sayli U.
        Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation.
        J Hand Surg Am. 2002; 27: 322-324
        • Gilpin D.
        • Coleman S.
        • Hall S.
        • Houston A.
        • Karrasch J.
        • Jones N.
        Injectable collagenase clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease.
        J Hand Surg Am. 2010; 35: 2027-2038.e1
        • Kaplan F.T.
        • Badalamente M.A.
        • Hurst L.C.
        • Merrell G.A.
        • Pahk R.
        Delayed manipulation after collagenase clostridium histolyticum injection for Dupuytren contracture.
        Hand (N Y). 2015; 10: 578-582
        • Mickelson D.T.
        • Noland S.S.
        • Watt A.J.
        • Kollitz K.M.
        • Vedder N.B.
        • Huang J.I.
        Prospective randomized controlled trial comparing 1- versus 7-day manipulation following collagenase injection for dupuytren contracture.
        J Hand Surg Am. 2014; 39: 1933-1941.e1
        • Scherman P.
        • Jenmalm P.
        • Dahlin L.B.
        One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren's contracture: a two-centre prospective randomized clinical trial.
        J Hand Surg Eur Vol. 2016; 41: 577-582
        • Citron N.
        • Nunez V.
        Recurrence after surgery for dupuytren's disease: a randomized trial of two skin incisions.
        J Hand Surg Br. 2005; 30: 563-566
        • Bulstrode N.
        A prospective randomised clinical trial of the intra-operative use of 5-fluorouracil on the outcome of Dupuytren's disease.
        J Hand Surg J Br Soc Surg Hand. 2004; 29: 18-21
        • McMillan C.
        • Binhammer P.
        Steroid injection and needle aponeurotomy for Dupuytren contracture: a randomized, controlled study.
        J Hand Surg Am. 2012; 37: 1307-1312
        • McMillan C.
        • Binhammer P.
        Steroid injection and needle aponeurotomy for Dupuytren disease: long-term follow-up of a randomized controlled trial.
        J Hand Surg Am. 2014; 39: 1942-1947
        • Bhatia R.
        Comparative study of “staples versus sutures” in skin closure following dupuytren's surgery.
        J Hand Surg J Br Soc Surg Hand. 2002; 27: 53-54
        • Degreef I.
        • Tejpar S.
        • Sciot R.
        • De Smet L.
        High-dosage tamoxifen as neoadjuvant treatment in minimally invasive surgery for Dupuytren disease in patients with a strong predisposition toward fibrosis: a randomized controlled trial.
        J Bone Joint Surg Am. 2014; 96: 655-662
        • Hazarika E.Z.
        • Knight M.T.
        • Frazer-Moodie A.
        The effect of intermittent pneumatic compression on the hand after fasciectomy.
        Hand. 1979; 11: 309-314
        • Kemler M.A.
        • Houpt P.
        • van der Horst C.M.
        A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren's disease.
        J Hand Surg Eur Vol. 2012; 37: 733-737
        • Collis J.
        • Collocott S.
        • Hing W.
        • Kelly E.
        The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.
        J Hand Surg Am. 2013; 38: 1285-1294.e2
        • Jerosch-Herold C.
        • Shepstone L.
        • Chojnowski A.J.
        • Larson D.
        • Barrett E.
        • Vaughan S.P.
        Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial.
        BMC Musculoskelet Disord. 2011; 12: 136
        • Peters-Veluthamaningal C.
        • Winters J.C.
        • Groenier K.H.
        • Meyboom-DeJong B.
        Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice.
        BMC Musculoskelet Disord. 2009; 10: 131
        • Pagonis T.
        • Ditsios K.
        • Toli P.
        • Givissis P.
        • Christodoulou A.
        Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique.
        Am J Sports Med. 2011; 39: 398-403
        • Kume K.
        • Amano K.
        • Yamada S.
        • Amano K.
        • Kuwaba N.
        • Ohta H.
        In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study.
        J Hand Surg Eur Vol. 2012; 37: 523-527
        • Orlandi D.
        • Corazza A.
        • Fabbro E.
        • et al.
        Ultrasound-guided percutaneous injection to treat de Quervain's disease using three different techniques: a randomized controlled trial.
        Eur Radiol. 2015; 25: 1512-1519
        • Jirarattanaphochai K.
        • Saengnipanthkul S.
        • Vipulakorn K.
        • Jianmongkol S.
        • Chatuparisute P.
        • Jung S.
        Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. A randomized, double-blind, placebo-controlled trial.
        J Bone Joint Surg Am. 2004; 86: 2700-2706
        • Hadianfard M.
        • Ashraf A.
        • Fakheri M.
        • Nasiri A.
        Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis: a randomized controlled trial.
        J Acupunct Meridian Stud. 2014; 7: 115-121
        • Mardani-Kivi M.
        • Karimi Mobarakeh M.
        • Bahrami F.
        • Hashemi-Motlagh K.
        • Saheb-Ekhtiari K.
        • Akhoondzadeh N.
        Corticosteroid injection with or without thumb spica cast for De Quervain tenosynovitis.
        J Hand Surg Am. 2014; 39: 37-41
        • Mehdinasab S.A.
        • Alemohammad S.A.
        Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain's tenosynovitis.
        Arch Iran Med. 2010; 13: 270-274
        • Menendez M.E.
        • Thornton E.
        • Kent S.
        • Kalajian T.
        • Ring D.
        A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy.
        Int Orthop. 2015; 39: 1563-1569
        • Jongprasitkul H.
        Elastic bandage vs. neoprene thumb stabilizer splint in acute.
        Asian Biomed. 2011; 5
        • Homayouni K.
        • Zeynali L.
        • Mianehsaz E.
        Comparison between kinesio taping and physiotherapy in the treatment of De Quervain's disease.
        J Musculoskelet Res. 2013; 16: 1350019
        • Tabinda H.
        • Mahmood F.
        De quervain's tenosynovitis and phonophoresis: a randomised controlled trial in pregnant females. de quervain.
        J Orthop Trauma Rehabil. 2015; 19: 2-6
        • Sharma R.
        • Thukral A.
        • Kumar S.
        • Bhargava S.
        Effect of low level lasers in de Quervains tenosynovitis.
        Physiotherapy. 2002; 88: 730-734
        • Sharma R.
        • Aggarwal A.N.
        • Bhatt S.
        • Kumar S.
        • Bhargava S.K.
        Outcome of low level lasers versus ultrasonic therapy in de Quervain's tenosynovitis.
        Indian J Orthop. 2015; 49: 542-548
        • Kang H.J.
        • Koh I.H.
        • Jang J.W.
        • Choi Y.R.
        Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial.
        Bone Joint J. 2013; 95: 947-951
        • Benson L.S.
        • Ptaszek A.J.
        Injection versus surgery in the treatment of trigger finger.
        J Hand Surg Am. 1997; 22: 138-144
        • Rhoades C.E.
        • Gelberman R.H.
        • Manjarris J.F.
        Stenosing tenosynovitis of the fingers and thumb. Results of a prospective trial of steroid injection and splinting.
        Clin Orthop Relat Res. 1984; : 236-238
        • Rozental T.D.
        • Zurakowski D.
        • Blazar P.E.
        Trigger finger: prognostic indicators of recurrence following corticosteroid injection.
        J Bone Joint Surg Am. 2008; 90: 1665-1672
        • Girlanda P.
        • Dattola R.
        • Venuto C.
        • Mangiapane R.
        • Nicolosi C.
        • Messina C.
        Local steroid treatment in idiopathic carpal tunnel syndrome: short- and long-term efficacy.
        J Neurol. 1993; 240: 187-190
        • Smidt N.
        • van der Windt D.A.
        • Assendelft W.J.
        • Devillé W.L.
        • Korthals-de Bos I.B.
        • Bouter L.M.
        Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.
        Lancet. 2002; 359: 657-662
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        • Smeraglia F.
        • Del Buono A.
        • Maffulli N.
        Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.
        Br Med Bull. 2016; 118: 149-158
        • Richie C.A.
        • Briner W.W.
        Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation.
        J Am Board Fam Pract. 2003; 16: 102-106
        • Orlandi D.
        • Corazza A.
        • Silvestri E.
        • et al.
        Ultrasound-guided procedures around the wrist and hand: how to do.
        Eur J Radiol. 2014; 83: 1231-1238
        • Ryzewicz M.
        • Wolf J.M.
        Trigger digits: principles, management, and complications.
        J Hand Surg Am. 2006; 31: 135-146
        • Hurst L.C.
        • Badalamente M.A.
        Nonoperative treatment of Dupuytren's disease.
        Hand Clin. 1999; 15 (vii): 97-107
        • Anderson B.C.
        • Manthey R.
        • Brouns M.C.
        Treatment of De Quervain's tenosynovitis with corticosteroids. A prospective study of the response to local injection.
        Arthritis Rheum. 1991; 34: 793-798
        • Finkelstein H.
        Stenosing tendovaginitis at the radial styloid process.
        J Bone Joint Surg Am. 1930; 12: 509-540
        • Stein H.
        Stenosing tendovaginitis.
        Am J Surg. 1927; : 77-78