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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:https://doi.org/10.1016/j.apmr.2017.07.014

      Abstract

      Objectives

      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.

      Conclusions

      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.

      Keywords

      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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