Over the last several months I have treated a woman in her 60s, Ms H, with wrist tendinitis.
DeQuervain’s tenosynovitis is a painful tendinitis of the wrist tendons at the base of the thumb that extends up the forearm. Any sort of activity that stresses the wrist in this area can cause this problem. In Ms H’s case she had so much pain in her right wrist that she was having difficulty doing her normal everyday activities. Before seeing me she had already tried the traditional first line treatment options, including 2 steroid injections, had her thumb immobilized in a splint, and used anti-inflammatory pills, all without any meaningful benefit. She was not able to go to occupational therapy due to the intensity of her pain. She even developed a rash over her wrist from an anti-inflammatory cream she had applied. Finally she was offered surgery for her tendinitis.
At the point I saw Ms H the quality of her life was significantly reduced due to her wrist pain. Activities she normally enjoyed she was no longer able to do. We discussed her treatment options and proceed to treat her Dequervain’s tenosynovitis with PRP. After 2 treatments her pain was 60% improved. She still had functional limitations using her wrist due to several months of inactivity, but was improving with her activities of daily living. Given the reduction of pain she has restarted occupational therapy, this time actually being able to participate in her therapy due to the decrease in pain. Hopefully OT can get her further improvement at this point. If not, a booster PRP treatment can be considered.
It’s been shown that PRP for tendinitis seems to work better if a steroid injection has not been used previously. In most cases of tendinitis that have not responded to physical therapy alone PRP is likely a more appropriate first intervention rather than steroids. Yet in reality PRP is used as a last resort option, partially due to lack of awareness on the part of the physician, and also due to health insurance resistance to covering these treatments. In the case of Ms H, this last option made a big difference. She’s had damage to her wrist tendons and may never go back to being 100%. But her improvement with a safe and conservative treatment that works has enabled her to go back to living and enjoying a normal life.