(548) Prolotherapy treatment for Dequervain's Tenosynovitis and Intersection Syndrome

Abstract

A 62-year-old female laboratory assistant presented to our clinic with chronic pain of the radial and dorsal aspect of the wrist. The pain was aggravated with an increased use of her hands, and improved with ice and anti-inflammatories. On examination, the patient demonstrated a positive Finkelstein’s test and tenderness over the radial styloid process. A musculoskeletal ultrasound evaluation performed in clinic revealed edema in the 1st dorsal compartment around the flexor pollicis longus and extensor pollicis brevis, confirming the suspicion for a diagnosis of Dequervain’s Tenosynovitis with Intersection Syndrome. An ultrasound-guided steroid injection was subsequently performed in the first dorsal compartment and the intersection of the first and second dorsal compartments of the wrist. The injections provided complete pain relief for approximately 2 months. When the pain returned, the patient did not desire further steroid injections due to concern for its systemic effects. The patient was agreeable to prolotherapy injections, and a repeat injection was performed with a 4mL mixture of 1% lidocaine and 12.5% dextrose. The patient had complete pain relief for approximately 2 months; results similar to the prior steroid injection. The patient now returns for repeat injections every 2-3 months without any concerns for the systemic effects of steroids. Prolotherapy is an injection-based treatment for chronic musculoskeletal pain. Its proposed mechanism for pain relief is the reduction of pain through the strengthening of stretched or torn ligaments. Proponents of prolotherapy believe the injections trigger an influx of granulocytes, macrophages, and fibroblasts, which then release of growth factors and ultimately collagen deposition, leading to strengthening of ligaments. Ultimately, this may lead to a reduction in pain and disability. This is the first report, to our knowledge, for the use of prolotherapy to successfully treat Dequervain’s Tenosynovitis and Intersection Syndrome. A 62-year-old female laboratory assistant presented to our clinic with chronic pain of the radial and dorsal aspect of the wrist. The pain was aggravated with an increased use of her hands, and improved with ice and anti-inflammatories. On examination, the patient demonstrated a positive Finkelstein’s test and tenderness over the radial styloid process. A musculoskeletal ultrasound evaluation performed in clinic revealed edema in the 1st dorsal compartment around the flexor pollicis longus and extensor pollicis brevis, confirming the suspicion for a diagnosis of Dequervain’s Tenosynovitis with Intersection Syndrome. An ultrasound-guided steroid injection was subsequently performed in the first dorsal compartment and the intersection of the first and second dorsal compartments of the wrist. The injections provided complete pain relief for approximately 2 months. When the pain returned, the patient did not desire further steroid injections due to concern for its systemic effects. The patient was agreeable to prolotherapy injections, and a repeat injection was performed with a 4mL mixture of 1% lidocaine and 12.5% dextrose. The patient had complete pain relief for approximately 2 months; results similar to the prior steroid injection. The patient now returns for repeat injections every 2-3 months without any concerns for the systemic effects of steroids. Prolotherapy is an injection-based treatment for chronic musculoskeletal pain. Its proposed mechanism for pain relief is the reduction of pain through the strengthening of stretched or torn ligaments. Proponents of prolotherapy believe the injections trigger an influx of granulocytes, macrophages, and fibroblasts, which then release of growth factors and ultimately collagen deposition, leading to strengthening of ligaments. Ultimately, this may lead to a reduction in pain and disability. This is the first report, to our knowledge, for the use of prolotherapy to successfully treat Dequervain’s Tenosynovitis and Intersection Syndrome.