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De Quervain tenosynovitis is a disease affecting
tendons of the first dorsal compartment of the wrist. These
tendons are APL and EPB. They are affected in females
more than males, the incidence of this disease among
population is not known accurately uptill now.
It may be due to an acute trauma or a part of a
systemic inflammatory disease, but commonly it is due to
repetitive micro trauma and overuse of the thumb. Pregnant
females may complain of this disease due to edema and
postpartum females due to handling their babies.
De Quervain is common in the age group 30-50
years old, but nowadays it may affect teenagers who use
their cell phones in texting messages frequently.
Patients are complaining of moderate to severe pain,
tenderness and sometimes swelling over the radial styloid,
radiating up to the forearm and distally to the thumb.
Limitations of motion and sensory affection may be
detected in some patients.
De Quervian syndrome is mainly diagnosed
clinically, by looking for swelling and palpating tenderness
at the 1st dorsal compartment of the wrist. The most
common special test used is Finkelstein test which is found
positive. Diagnosis is based on a combination of clinical
signs, symptoms and abnormal findings in the MSUS.
Treatment of De Quervain disease falls under two
strategies: conservative and surgical. Conservative
treatment is generally offered to patients as the first line of
treatment, including thumb Spica, NSAIDS, physiotherapy,
restricted activities and injections.
PRP injection is considered non-surgical new
modality in treatment of this disease. It is autologous blood
plasma with platelet concentration above normal. Platelet
concentration 4–5 times higher than baseline was sufficient
to induce bone and soft tissue healing.
Our study aims to determine the efficacy of the PRP
in the treatment of De Quervian tendinopathy that induces
self-healing of the tendons.
This study was randomly conducted at the
Department of Physical Medicine, Rheumatology and
Rehabilitation at Ain Shams University Hospital on 20
patients diagnosed with De Quervain tenosynovitis, they
are 14 females and 6 males. Their age group was from 23 to
56 years old and the disease duration ranged from 2 months
to 2.5 years.
We collected 20 ml of the whole blood from each
patient for centrifugation to separate 2 ml PRP. There are
many techniques of separation and preparation of the PRP
for tendon injection. We used the double spin technique, the
soft spin followed by the hard (1800 rpm for 15 mins then
3500 rpm for 10 mins).
Patients were assessed before and one month after
receiving the injection. Examination is done using visual
analogue scale and MSUS. VAS is to assess the pain
intensity and MSUS is for TS and vascularity.
Tenosynovitis significantly decreased after the
injection of PRP (P < 0.001), Tenosynovitis improved in 18
patients, this means that 90% of the patients improved and
10% remained stable.
As regards the vascularity, no significant change
was seen in patients before and after treatment (P = 0.365).
Regarding the vascularity 25% of the patients showed
improvement, 15% deteriorated and 65% remained stable.
A highly significant difference was seen between
VAS values before treatment as compared to after treatment
(P<0.001).The mean value of reduction was equal to 3
showing high significance (P< 0.001). VAS improved in
95% of the patients, only 5 % were stable.