Platelet-rich Plasma in the Treatment of Recurrent Flexor Tenosynovitis of Wrist Complicated with Carpal Tunnel Syndrome in a Patient with Type 2 Diabetes Mellitus: A Case Report.

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.