Corticosteroid injections for the treatment of hand and wrist disorders in general practice Peters-Veluthamaningal, Cyriac

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1 University of Groningen Corticosteroid injections for the treatment of hand and wrist disorders in general practice Peters-Veluthamaningal, Cyriac IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2009 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Peters-Veluthamaningal, C. (2009). Corticosteroid injections for the treatment of hand and wrist disorders in general practice Groningen: s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:

2 Corticosteroid injections for the treatment of hand and wrist disorders in general practice

3 The Groningen Hand and Wrist Injection Therapy Trial (HAWITT) was financially supported by the fund for Common Disorders of the Dutch College of General Practitioners and by an unrestricted educational grant from the pharmaceutical company Bristol-Myers Squibb.! 2009 Cyriac Peters-Veluthamaningal Ontwerp omslag: Ridderprint, Ridderkerk Foto omslag: Auguste Rodin, Les Mains. Image Copyright The Metropolitan Museum of Art, Artists Rights Society (ARS), New York Ontwerp binnenwerk: Antje Peters-Veluthamaningal Drukwerk: Ridderprint, Ridderkerk ISBN:

4 RIJKSUNIVERSITEIT GRONINGEN Corticosteroid injections for the treatment of hand and wrist disorders in general practice Proefschrift!"#$%"#&#'()'*)$%+*$,"!$-./!.#++!$'*$-"$ 0"-'1/,"$2"!"*1/,+33"*$ ++*$-"$4'(&15*'%"#1'!"'!$6#.*'*)"*$.3$)"7+)$%+*$-"$ 4"/!.#$0+)*'8'/519$-#:$;:$<=+#!19$ $ -..#$ $ Cyriac Peters-Veluthamaningal geboren op 11 februari 1967 te Münster, Duitsland

5 Promotor: Prof. dr. B. Meyboom de Jong Copromotor: Dr. J. C. Winters Beoordelingscommissie: Prof. dr. R.A. de Bie Prof. dr. B.W. Koes Prof. dr. P.M.N. Werker

6 ..."The men where you live," said the little prince, "raise five thousand roses in the same garden and they do not find in it what they are looking for." "They do not find it," I replied. "And yet what they are looking for could be found in one single rose, or in a little water." "Yes, that is true," I said. And the little prince added: "But the eyes are blind. One must look with the heart..." The little Prince, Antoine de Saint-Exupéry (translated by Katherine Woods)

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8 Voor mijn ouders

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10 Preface Preface It was in 2000, just after finishing my vocational training in general practice, that I decided to write a PhD-thesis. Not ready to settle as a general practitioner yet, I noticed while observing colleagues who had already acquired a doctorate that their systematic way of analyzing and managing health problems of patients in daily clinical practice appealed to me. I asked professor Betty Meyboom, then head of the department of General Practice of the University of Groningen, for her opinion on choosing an subject to study and after some brainstorming we decided that the subject of my scientific exercitions would be the treatment of hand of wrist disorders with corticosteroid injections, since dr. Jan Winters had been able to acquire funds to research the subject shortly before. After writing a study-protocol I started including patients in 2002 for the three trials described in this thesis with high ambition and great enthusiasm. What I did not realized then was that this project was going to be my very own Odyssey experience for nearly the next ten years of my life. During this epic voyage there have been difficult moments when motivation or time were lacking, especially after I started my private practice in 2002 in Scheemda. There were times when I was not able to work on my thesis for weeks, severely falling behind schedule (luckily, Betty Meyboom and Jan Winters were always there to boost my morale). Designing and carrying out three randomized controlled trials in general practice without hardly any personal assistance turned out to be monkish work. To overcome my innere Schweinehund (a German expression for one's weaker self) turned out to be one of the biggest hurdles. Soon I came to realize that writing a PhD-thesis is more than anything a test in perseverance, one s ability to adhere to a commitment made in life and the ability to cope with setbacks (for example when the results of a trial were not what I expected or a submitted paper was rejected by a journal). During the past years I learned that not only enthusiasm, curiosity and creativity but also self-discipline, patience, dedication and sense of self-responsibility are crucial pre-requisites for successfully acquiring a doctorate. There were also many, many rewarding moments. For example when the first data were analyzed and indicated that participating patients were responding well to trial intervention and improved in their clinical condition. The process of collaborating with scientists (when writing the systematic reviews) from different countries from three continents was tremendously inspiring. To see an article being published in a high impact medical journal, after a time-consuming and elaborate peer-reviewing process, is a success experience which gave me lots of energy and boosted my confidence. Combining clinical practice with research was also a very satisfying experience. There were times when I would deal one day with severe illness and suffering of patients in my practice, the next day analyzing dry data from my trials. Nowadays I try to approach daily clinical problems in general practice more in a systematical and analytical way than before and I came to learn that it is important for medical research to be practical and to focus on solutions for relevant clinical problems that matter to individual patients.

11 Today, I look back at the past nine years with great pride and satisfaction. It was an experience that I would not have wanted to have missed and there is no doubt that I will profit for the rest of my life from the experiences that I gained and the knowledge and skills that I have acquired during this part of my career and life that was dedicated to science. Raju Peters Groningen, 21 september 2009

12 Table of contents Table of contents Chapter 1 Introduction 13 Chapter 2 Corticosteroid injection for trigger finger in adults (systematic review) 23 Chapter 3 Corticosteroid injection for de Quervain's tenosynovitis (systematic review) 53 Chapter 4 Randomized controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice 73 Chapter 5 Corticosteroid injections effective for trigger finger in adults in general practice: a doubleblinded randomized placebo controlled trial 93 Chapter 6 Randomized controlled trial of local corticosteroid injections for de Quervain s tenosynovitis in general practice 109 Chapter 7 Psychometric properties of a Dutch version of the Boston Carpal Tunnel Questionnaire 125 Chapter 8 General discussion 143 Summary 153 Samenvatting 159 Dankwoord 165$