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Systematic Review and Meta-Analysis on the Work-Related Cause of de Quervain Tenosynovitis: A Critical Appraisal of Its Recognition as an Occupational Disease

Stahl, Stéphane M.D.; Vida, Daniel; Meisner, Christoph Sc.D.; Lotter, Oliver M.D.; Rothenberger, Jens M.D.; Schaller, Hans-Eberhard M.D., Ph.D.; Stahl, Adelana Santos M.D.

Plastic and Reconstructive Surgery: December 2013 - Volume 132 - Issue 6 - p 1479–1491
doi: 10.1097/01.prs.0000434409.32594.1b
Hand/Peripheral Nerve: Outcomes Article
Expert

Background: The authors systematically reviewed all of the etiopathologic factors discussed in the literature to verify the classification of de Quervain tenosynovitis on the list of occupational diseases.

Methods: The authors searched Ovid MEDLINE, EMBASE, and the Cochrane Library for articles discussing the cause of de Quervain tenosynovitis. The literature was classified by the level of evidence presented, the etiopathologic hypothesis discussed, the authors’ conclusion about the role of the etiopathologic hypothesis, and the first author’s professional background. The quality of reporting of the observational studies was evaluated by an extended Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. A meta-analysis of all controlled cohort studies was performed. The Bradford Hill criteria were used to evaluate a causal relationship between de Quervain tenosynovitis and occupational risk factors.

Results: A total of 179 references were found, and 80 articles were included. On average, only 35 percent (median, 35 percent; range, 16 to 60 percent) of all items on the extended Strengthening the Reporting of Observational Studies in Epidemiology checklist were addressed per article. The meta-analysis to evaluate the strength of the association between de Quervain tenosynovitis and (1) repetitive, (2) forceful, or (3) ergonomically stressful manual work suggested an odds ratio of 2.89 (95 percent CI, 1.4 to 5.97; p = 0.004). No evidence was found to support the Bradford Hill criteria for a causal relationship between de Quervain tenosynovitis and occupational risk factors.

Conclusion: No sufficient scientific evidence was provided to confirm a causal relationship between de Quervain tenosynovitis and occupational risk factors.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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Tübingen and Stuttgart, Germany

From the Department of Plastic, Hand, and Reconstructive Surgery, Burn Center, BG-Trauma Center, and the Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University of Tübingen; and the Department for Plastic Surgery, Marienhospital Stuttgart.

Received for publication May 17, 2013; accepted June 20, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. There was no direct funding of this study by any commercial source.

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Stéphane Stahl, M.D., Department of Plastic, Hand, and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstrasse 95, 72076 Tübingen, Germany, sstahl@bgu-tuebingen

©2013American Society of Plastic Surgeons