Corticosteroid injections for the treatment of hand and wrist disorders in general practice

Abstract

General practitioners are frequently consulted by their patients for hand and wrist disorders, such as carpal tunnel syndrome, trigger finger or de Quervain’s tenosynovitis. These disorders are important causes for disability, health-care consumption and absence from work. Local corticosteroid injection is one of the treatment options that can be used for managing these conditions. The aim of this thesis is to contribute to the body of evidence concerning effectiveness and safety of corticosteroid injections for carpal tunnel syndrome, trigger finger and de Quervain’s tenosynovitis, in particular when applied in general practice. Chapter 2 of the thesis presents the results of a systematic review assessing effectiveness of local corticosteroid injections for the treatment of trigger finger in adults and chapter 3 presents the results of a systematic review assessing effectiveness of local corticosteroid injections for the treatment of de Quervain’s tenosynovitis. Both systematic reviews were written according to the conventions of the Cochrane Collaboration and published in the Cochrane Library. Chapters 4, 5, 6 describe the results of a randomized controlled trial in general practice, investigating the effectiveness of injections with triamcinolonacetonide versus placebo injection (NaCl) for respectively carpal tunnel syndrome, trigger finger and de Quervain’s tenosynovitis. The results indicate that patients presenting to general practitioners with carpal tunnel syndrome, trigger finger and de Quervain’s tenosynovitis can effectively be treated with local corticosteroid injections. Chapter 7 focuses on the measurement properties reliability, responsiveness and interpretability of the Dutch version of the Boston Carpal Tunnel Questionnaire. We translated the BCTQ into Dutch for use as an outcome assessment tool in the randomised controlled study described in chapter 4. In Chapter 8 the findings of the previous chapters are interpreted and implications for daily practice and future research are discussed. Finally a summary in English and Dutch are given.