First identified by Swiss surgeon Fritz de Quervain in 1895, De Quervain’s tenosynovitis is characterized by tenosynovial thickening and stenosis of the first dorsal compartment. This impairs abductor pollicis longus and extensor pollicis brevis tendon gliding, leading to pain over the radial styloid and to functional limitations [1], [2], [3]. Pathophysiology is ambiguous, but the condition appears to derive from repeated microtrauma and overuse, with histopathological findings of fibrotic thickening and myxoid degeneration of the tendon sheath [4]. De Quervain's tenosynovitis mainly affects middle-aged females, with a reported prevalence of 0.5% in men and 1.3% in women [5].

Conservative management traditionally comprised behavioral modification, anti-inflammatory medication and immobilization of the wrist and thumb, typically by thumb spica cast, to allow tendon rest. Furthermore, corticosteroid injection directly into the tendon sheath induces localized anti-inflammatory effects and was shown to be effective in reducing pain for patients with De Quervain’s tenosynovitis [6], [7]. Though both immobilization and steroid injection are common options for De Quervain’s tenosynovitis, it is unclear whether one modality offers more benefit than the other.

Previous reviews comparing the efficacy of these two treatment modalities were based on a limited number of studies, and with high risk of bias [8], [9], [10], [11]. The latest systematic review and meta-analysis was published by Cavaleri et al. almost a decade ago and included 5 randomized controlled trials [8]. The authors found no significant difference in efficacy between corticosteroid injection and immobilization. However, since then, numerous new randomized trials have been conducted that could perhaps impact the findings of a meta-analysis. Hence, there is a rationale and need for the present review.

We performed an updated systematic review and meta-analysis comparing the efficacy of corticosteroid injection and of immobilization for the treatment of De Quervain’s tenosynovitis, to determine whether one treatment was superior to the other and to offer guidance to clinicians and surgeons in treatment decision-making.