Houston Methodist. Leading Medicine

Hand FAQ

Question:

I am an occupational therapist in a large hand clinic in the midwest. I've been given the task of researching what works and what doesn't work for several hand conditions that we see routinely. Before I go and reinvent the wheel, I'm wondering if someone else has already done something like this that I could use to get started?

Answer:

Actually, you may be in luck. Researchers from the Netherlands took the time to review studies published and listed in PubMed (search engine for the U.S. government's record of publications in the National Library of Medicine). They confined themselves to four specific hand disorders: 1) trigger finger, 2) Raynaud's phenomenon, 3) Dupuytren's disease, and 4) De Quervain's disease. That's the good news. The bad news is they didn't really find much to help them develop any kind of treatment guidelines for these conditions. There simply aren't very many good, quality studies out there. The conclusion of their article was that there is a big need for some high-quality research in the area of effective treatment for painful conditions of the hand. In the meantime, here's a quick summary of what they did find. Steroid injections might be useful in the treatment of trigger finger, but there was only one (very small) study that compared steroid injections with a placebo injection so more study is needed in this area. Raynaud's phenomenon (RP) responded best to medications such as calcium channel blockers (to lower the blood pressure by keeping the blood vessels open). Laser therapy may also be effective. There was limited evidence to support the effectiveness of behavioral therapy with biofeedback (for temperature control) and the use of supplements like Ginkgo Biloba. There were only four randomized controlled trials centered on the treatment of Dupuytren disease. Those all had to do with surgery, type of incision made, and postoperative procedures to control swelling. There was no evidence that any one particular approach worked best or had the most positive effects. Studies of cortisone injections (with or without antiinflammatory drugs) and splinting did not show either one to be effective in treating the symptoms of De Quervain's disease. Wearing a splint reduced pain for some patients but it didn't last. As soon as the splints were removed and the thumb moved, the pain came right back. Injections seem to help, as two-thirds of the group was better three weeks later. But that was the same result as in the placebo group. A lack of evidence is NOT the same as evidence that the treatment doesn't work or should/should not be used. It just means that we have to get busy and do some studies in this area with a specific focus on treatment approaches for each hand disorder being considered. Marienke van Middelkoop, PhD, et al. Effectiveness of Interventions of Specific Complaints of the Arm, Neck, or Shoulder (CANS). Musculoskeletal Disorders of the Hand. In The Clinical Journal of Pain. July-August 2009. Vol. 25. No. 6. Pp. 537-552.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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