A STUDY TO COMPARE THE EFFICACY, FEASIBILITY AND DURABILITY OF CONSERVATIVE & PHYSICAL THERAPY, CORTICOSTEROID THERAPY AND PLATELET RICH PLASMA THERAPY IN PATIENTS SUFFERING FROM DE QUERVAIN’S TENOSYNOVITIS: A PROSPECTIVE COHORT STUDY

Abstract

Background: de Quervain’s stenosing tenosynovitis (dQSTS) is a tenosynovial disorder which is characterized by impaired gliding of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscles over the tendon sheath covering these tendons. The most sensitive clinical test to diagnose dQSTS is Finkelstein's manoeuvre. The management of the disease differs based on the severity of the condition. Objectives: To prospectively review and compare the efficacy, feasibility and durability of conservative & physical therapy, corticosteroid therapy and platelet rich plasma therapy in the view of (1) symptomatic pain relief, (2) improved the visual analogue scale (VAS) score and functional Mayo’s wrist scores, (3) durability of treatment given and (4) alleviation of need of surgery in patients with de Quervain’s tenosynovitis. Materials and Methods: After screening of cases, 217 cases entered into the study and the cases were randomized into three groups according to our study protocol. Group a cases were treated with conservative & physical therapy, Group B cases were treated with corticosteroid therapy and Group C cases were treated with autologous platelet rich plasma injection with due pre and post procedural care. The cases were followed up on day 0, at the end of 1st week, 1st and 6th month for pain and range of movements. The patients were followed up for complications and the data were analysed statistically. Results: A total of 25 (30.06%) cases in group A, 48 (69.56%) cases in group B and 64 (95.52%) cases in group C had recovered from disease at the end of 2nd dose of treatment. At the end of 6th month follow up, a total of 39 (60.93%) cases in group A, 21 (30.43%) cases in group B and 3 (4.47%) cases in group C had recurrence. All these patients were followed up for 1 year which showed a statistical difference with P value of <0.001 in VAS score and 0.001 in Mayo’s wrist scores among all three groups. No adverse reactions and serious complications are noted in the study participants. Conclusion: Percutaneous needling with autologous PRP injection is the superior modality for de Quervain’s tenosynovitis which minimise the pain and improve the functional quality of life. Keywords: Platelet rich plasma; de Quervain's stenosing tenosynovitis; Corticosteroid; Percutaneous needling