الفهرس | Only 14 pages are availabe for public view |
Abstract 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 114 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 115 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. |