Conservative Management Of De Quervain's Stenosing Tenosynovitis: An Evidence-based Treatment Algorithm
Jad Abi-Rafeh, MSc, Roy Kazan, MD, PhD, Tyler Safrsan, MD, Stephanie Thibaudeau, MD, FRCSC.
McGill University, Montreal, QC, Canada.
PURPOSE: Non-surgical management of De Quervain's disease relies mainly on the use of oral Non-Steroidal Anti-Inflammatory Drug administration, splint therapy, and corticosteroid injections. While the latter is most effective, with documented success rates of 61%-83%, there exists no clear consensus pertaining to conservative treatment protocols conferring the best outcomes. This article reports on all present conservative treatment modalities in use for the management of De Quervain's disease and highlights specific treatment- and patient-related factors associated with the best outcomes. METHODS: A systematic search was performed using the PubMed database using appropriate search terms; two independent reviewers evaluated retrieved articles using strict inclusion and exclusion criteria.
RESULTS: A total of 66 articles met the inclusion criteria for review, comprising 22 articles reporting on outcomes following a single conservative treatment modality, 8 articles reporting on combined treatment approaches, 13 articles directly comparing different conservative treatment regimens, and 23 case reports.
CONCLUSION: A multimodal approach using splint therapy and corticosteroid injections appears to be more beneficial than either used in isolation. Multi-point injection techniques and multiple injections prior to surgical referral may provide benefit over a single point injection technique and a single injection prior to surgery. Ultrasound was proven valuable in the visualization of an intercompartmental septum, while ultrasound-guided injections were shown to be both more accurate and confer better outcomes. Several prior and concurrent medical conditions may affect conservative treatment outcome. A level I-II evidence-based treatment protocol is recommended for the optimal non-surgical management of De Quervain's disease.
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