Effectiveness of interventions of specific complaints of the arm, neck, or shoulder (CANS): musculoskeletal disorders of the hand

Clin J Pain. 2009 Jul-Aug;25(6):537-52. doi: 10.1097/AJP.0b013e31819ff52c.


Objectives: The aim of this study was to provide an evidence-based overview of the effectiveness of (conservative and surgical) interventions for the 4 specific pain disorders of the hand: trigger finger, primary Raynaud's phenomenon, Dupuytren disease, and De Quervain's disease. This information can help clinicians in the selection of interventions in daily practice, and may give direction to future research.

Methods: Relevant review publications and randomized clinical trials (RCTs) in PubMed were searched. Data extraction and quality assessment were performed. To summarize the results of the included reviews and RCTs, a best-evidence synthesis was used.

Results: For primary Raynaud's phenomenon (1 review, 20 RCTs), we found strong evidence for calcium channel blockers and moderate evidence for laser therapy. Limited evidence was found for Ketanserin, Prozasin, Buflomedil, transdermal glyceryl trinitrate patches, Ginkgo biloba, and behavioral treatment with temperature feedback. Other interventions did not show clear favorable treatment effects. For Trigger finger one very small RCT was found that showed limited evidence for steroid injection. For Dupuytren disease (4 RCTs) limited evidence was found in favor of use of staples versus sutures in the Dupuytren's surgery, and for intermittent compression on the postoperative hand after surgery. For other interventions no clear positive effects could be demonstrated. For De Quervain's disease (2 RCTs), we found no efficacy of Nimesulide as addition to a Triamcinolone injection, and no clear differences between a corticosteroid injection and a splint in pregnant patients or patients breast-feeding.

Discussion: Well-designed and well-conducted RCTs are clearly needed in this field.

Publication types

  • Review

MeSH terms

  • Arm / physiopathology*
  • Arm / surgery
  • Female
  • Hand / physiopathology*
  • Hand / surgery
  • Humans
  • Musculoskeletal Diseases / pathology*
  • Musculoskeletal Diseases / surgery
  • Musculoskeletal Diseases / therapy*
  • Neck / physiopathology*
  • Neck / surgery
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Shoulder / physiopathology*
  • Shoulder / surgery