Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA.
Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2019 Oct;47(12):3019-3029. doi: 10.1177/0363546518801914. Epub 2018 Oct 31.
Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB).
To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo.
Systematic review and meta-analysis.
Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009).
Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up.
Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.
针对桡侧伸腕短肌肌腱病已有多种治疗方法被提出。
（1）比较在短期、中期和长期随访中描述的桡侧伸腕短肌肌腱病的非手术治疗选择的疗效和安全性；（2）评估接受安慰剂治疗的患者的结果。
系统评价和荟萃分析。
根据 PRISMA 指南，检索了 4 个电子数据库，以查找桡侧伸腕短肌肌腱病的随机安慰剂对照试验。纳入报告视觉模拟量表（VAS）疼痛评分和/或握力的研究。使用标准化均数差和比值比，采用随机或固定效应荟萃分析比较至少有 2 项合格研究的治疗方法。研究方案在 PROSPERO 注册（ID：CRD42018075009）。
共纳入 36 项随机安慰剂对照试验，评估了 11 种不同的治疗方法，共 2746 例患者。在短期随访时，只有局部皮质类固醇注射可改善疼痛，但长期随访时疼痛比安慰剂差。在中期随访时，激光治疗和局部肉毒毒素注射可改善疼痛。在长期随访时，体外冲击波治疗可缓解疼痛。在握力方面，只有激光治疗与安慰剂相比具有更好的结果。虽然各种治疗方法的不良事件发生几率比值没有差异，但与安慰剂相比，它们都增加了不良事件的发生。在接受安慰剂的患者中，在短期随访时报告轻度或更轻疼痛的患者百分比从 2%急剧增加到中期随访时的 92%。
大多数患者在接受治疗后 4 周内接受安慰剂治疗，疼痛得到缓解。在最佳情况下，所有治疗方法仅提供较小的疼痛缓解，同时增加了不良事件的几率。因此，如果临床医生倾向于为特定患者提供治疗，他们可能会考虑在症状持续的前 4 周内进行疼痛缓解方案。在决定治疗或观察等待时，应考虑患者的具体因素。
