Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. INTRODUCTION: Although corticosteroid injections are often cited as best practice in the treatment of de Quervain's disease, no reviews have compared their effectiveness to a multimodal definition of hand therapy. PURPOSE: To compare the effectiveness of corticosteroid injections with that of i) hand therapy alone and ii) combined hand therapy/corticosteroid injection approaches in the treatment of de Quervain's disease. METHODS: Searches of key databases were performed to identify experimental studies published between January 1950 and November 2014. Outcome measures included treatment success, pain, quality of life, and function. RESULTS: Both corticosteroid injections and hand therapy improved pain and function from baseline, but between-group differences were not significant (across 6 studies). However, significantly more participants were treated successfully when combined orthosis/corticosteroid injection approaches were compared to i) orthoses (RR 0.53, 95% CI 0.35-0.80) and ii) injections alone (RR 0.76, 95% CI 0.64-0.89). CONCLUSION: Combined orthosis/corticosteroid injection approaches are more effective than either intervention alone in the treatment of de Quervain's disease. LEVEL OF EVIDENCE: 1a.