RESUMO
Introduction: Hand disorders are common manifestations in persons with diabetes mellitus. Flexor tenosynovitis (FTS) of the wrist is a relatively less common occurrence when compared with FTS of the finger. In the presence of uncontrolled diabetes, recurrence is not uncommon, and management may become difficult. There is no mention in the literature about the management of FTS in the wrist, especially in recurrent cases. Case Presentation: A 38-year-old lady presented with pain and swelling over the volar aspect of the wrist associated with weakness of the grasp. In addition, she reported tingling and a current-like sensation in the radial three and a half digits. Routine laboratory investigations and plain radiographs of the wrist and hand revealed no abnormalities. An ultrasound (USG) scan of the carpal tunnel showed thickening of the flexor tendons, surrounding hypo- to anechoic areas with enhanced color Doppler signal. In addition, there was associated thickening of the median nerve compared to the healthy side. She reported recurrence of the symptoms despite several trials of conservative management and one injection of local corticosteroid. We planned a single injection of platelet-rich plasma (PRP) under direct USG visualization in an in-plane and short-axis view. There was a significant improvement in both pain and function scores up to a 3-month follow-up. Conclusion: FTS of the wrist is a less commonly reported entity that can be missed with clinical examination only. A USG scan can help in the detection of this condition whenever the diagnosis is uncertain. In patients with uncontrolled diabetes, PRP injection appears to be a safe and appropriate treatment option that can improve pain and function scores in the moderate term.
RESUMO
PURPOSE: The objective of the study was to assess the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of patellar tendinopathy. METHODS: The PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials which compared PRP injection with other 'active treatment' interventions ('Non-PRP' injection and 'No-injection' treatments) or 'No-active treatment' interventions. Randomized and non-randomized clinical trials that had been published up to 15 November 2021, were included in the meta-analysis. The primary outcome, pain relief, was measured on a 'visual analog scale.' Secondary outcomes were knee functional activities and quality of life (QoL). The PRISMA guidelines were followed throughout the study. RESULTS: Eight comparative studies were identified for inclusion in the meta-analysis. Assessment of these studies revealed that there were no significant differences in pain relief, functional outcomes, and QoL in the short, medium, and long term between PRP injection and Non-PRP injection interventions. Similarly, comparison of PRP injection to the No-active treatment intervention showed no differences in short- and medium-term pain relief. However, when PRP injection was compared to the No-injection treatment intervention extracorporeal shock wave therapy (ECWT), the former was found to be more effective in terms of pain relief in the medium term (mean difference [MD] - 1.50; 95% confidence interval [CI] - 2.72 to - 0.28) and long term (MD - 1.70; 95% CI, - 2.90 to - 0.50) and functional outcomes in the medium term (MD 13.0; 95% CI 3.01-22.99) and long term (MD 13.70; 95% CI 4.62-22.78). CONCLUSIONS: In terms of pain relief and functional outcomes, the PRP injection did not provide significantly greater clinical benefit than Non-PRP injections in the treatment of patellar tendinopathy. However, in comparison with ESWT, there was a significant benefit in favor of PRP injection.
