Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review

Objectives: The management of wrist and hand's tenosynovitis remains challenging and needs to be individualized. Physical modalities are accepted among conservative treatments, but there is currently no systematic assessment of their role and efficacy. The aim of this review is to analyze the literature including studies dealing with the use of physical modalities in De Quervain disease, Dupuytren disease and trigger finger, in order to obtain indications for everyday clinical practice.

Methods: A systematic literature search of the following databases was conducted: MEDLINE (through PubMed), Cochrane Library, PEDro and Scopus. All kind of papers, except for case reports and case series, were included, due to the small amount of scientific evidence in literature about this topic. The inclusion criteria were papers regarding the effectiveness of conservative treatment with physical modalities of adult humans affected by De Quervain disease, Dupuytren disease and trigger finger. The review included articles in English language published before 10 May 2020. The exclusion criteria were papers whose topic were surgery or conservative treatment with therapeutic tools different from physical modalities for hand and wrist's tenosynovitis.

Results: The literature search identified 2422 papers, but only 15 were included in this review. While 10 of the 15 studies (66.6%) were RCTs, only 2 had a lower risk of bias according to the Cochrane library assessment tool. For the conservative treatment of De Quervain disease 7 papers were found, studying ultrasound therapy, low level laser therapy, phonoporesis, and anodyne therapy, alone or associated. For Dupuytren disease 3 papers were found, studying extracorporeal shock wave therapy (ESWT), temperature controlled high energy adjustable multi-mode emission laser, electron beam therapy and radiofrequency. For trigger finger 5 papers were found, studying ESWT and ultrasound therapy.

Conclusions: Laser therapy and therapeutic ultrasound were the most used and effective physical therapies for De Quervain tenosynovitis. ESWT was found the most efficient and safe therapy for Dupuytren disease; radiotherapy, electron beam therapy, targeted radiofrequency and laser therapy could be promising therapeutic options at Dupuytren's onset. ESWT turned out to be the most frequent physical mean used for functional improvement and pain control in trigger finger. However, more high-quality studies are still needed to further define evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.