We see many people at our practice with a long medical history of thumb pain and thumb pain treatments. These people would up seeing us because their long medical history of conservative care treatments, possibly surgery or surgical recommendation did not help them and they are seeking stem cell therapy or PRP platelet rich plasma therapy as options. Perhaps as options and an alternative to some type of hand surgery.
Thumb pain is often confused with wrist pain and carpal tunnel pain. The confusion with Carpal Tunnel Syndrome is the belief that there is some type of tendon involvement. The confusion with the wrist pain can lead to the belief that there is a ligament or osteoarthritis involvement. As an added layer of confusion doctors may find it difficult to determine if the person’s pain is coming from the wrist or thumb.
Is it De Quervain’s Tenosynovitis?
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- Tenosynovitis refers to the inflammation of the synovium that surrounds the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. These tendons move the thumb. Both of these tendons pass within a sheath called the synovium. Tenosynovitis is the Tendon-synovium-itis or inflammation. The tendons are being squeezed within this sheath.
- Is it flexor carpi radialis? Some people who report overuse, which is a common characteristic of thumb and wrist pain, will suggest a wrist pain when they flex their wrist. The pain center point being a spot behind the wrist. The flexor carpi radialis is one of the tendons that helps flex the hand at the wrist. When this tendon suffers from overuse it can swell and cause chronic pain and tenderness. Flexor carpi radialis and Quervain’s Tenosynovitis can be confused or can be occurring simultaneously.
The Finkelstein test
A diagnosis of De Quervain’s Tenosynovitis is usually made after a Finkelstein test. The test goes like this:
- Your thumb is bent into your hand and you make a fist.
- You then bend your wrist towards your pinky side.
- If you have pain at the back of your thumb you will probably be diagnosed with De Quervain’s Tenosynovitis
Mommy Thumb
De Quervain’s Tenosynovitis is also referred to as Mommy Thumb. This is an overuse injury unique to new mothers who frequently pick up and hold their new babies. You may know or knew a new mom who wore wrist braces.
The treatments
- Splints. Many people find splinting helpful, especially at night time when a painful thumb may awaken them or to prevent a numb thumb in the morning. Splints may help the thumb heal over time. The people I see have a long history of splint usage that was not effective for them.
- Anti-inflammatory medication (NSAIDs). Sometimes these will help with pain and discomfort but if the person is suffering from wear nd tear type injury, the NSAIDs will not heal it. NSAIDs will only mask the pain.
- Avoiding activities that make the pain worse. Usually the people I see are at the point now where they can no longer do these activities because of pain. Some do tell me that they did go through long periods of “rest” and the pain just returned when the resumed their work or activity.
- Corticosteroids.
Cortisone warnings
Here is a study that was recently published in the journal Musculoskeletal surgery.(1) It spells out the current concerns with cortisone injections.
“Steroid injection has been described as first line of management over many decades, but it is associated with some significant complications like depigmentation of skin, atrophy of subcutaneous tissue, suppurative tenosynovitis and even tendon rupture. Animal studies have also reported increased risk of peritendinous adhesions with steroid injection.”
Manual manipulation in the treatment of De Quervain’s Tenosynovitis
An April 2022 study (4) reported on three patients diagnosed with De Quervain’s Tenosynovitis treated with manual therapy. Many patients as summarized by the researchers do not respond to splinting, activity modification, medications, corticosteroid injections, physical therapist management, and surgery. These three patients underwent a multi-modal treatment regimen including carpometacarpal thrust and non-thrust manipulation, end range radiocarpal mobilization, mobilization with movement, strengthening exercises, and grip proprioception training.
The study investigators found that all three patients showed definitive improvements in standardized pain and functional outcome scores. That the patients were able to achieve these results with ten visits or less. Further, all three patients were able to return to their usual daily tasks without pain. The improvements were maintained at six month follow-up.
Non-Surgical options : Cortisone, PRP and Stem Cell Therapy
There is no direct study comparison comparing these treatments in a situation of De Quervain’s Tenosynovitis. As the condition of trigger finger is also a condition of Tenosynovitis we can suggest similar type outcomes.
This is a summary from my article Stem Cell Therapy and PRP therapy for stenosing tenosynovitis – Trigger finger
Since Tenosynovitis is considered a problem of inflammation some will think that the obvious treatment should be a strong anti-inflammatory, such as a cortisone injection. Others would rather not go down the cortisone route because of the well known side-effects as mentioned in the above study.
PRP vs cortisone
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. The platelets contain healing agents, or “growth factors.”
A research team in November 2020 (2) announced that they would conduct a study to compare PRP injections to cortisone injections for trigger finger or stenosing tenosynovitis. Prior research suggests “Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease.”
Further they write:
“PRP has been shown to reduce symptoms in different tendon pathologies with the rationale to potentially accelerate the healing process. PRP has positive effects on both short-term and long-term pain on tendon and ligament healing.
Stem Cell therapy
In our practice, Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.
There is no direct study on the effect of stem cell therapy on De Quervain’s Tenosynovitis. Like PRP above there is an expectation that the treatment would be beneficial based on successful treatments documented in the medical literature on other types of tendinopathies.
More recently a January 2020 study (3) suggested: “there have been over 100 studies using MSCs for tendon healing, and the majority of these studies has been published in the last 5 years. These studies have used the traditional bone marrow derived stromal cells (BMSCs), adipose derived stem cells (ASCs), endogenous ligament derived stem cells (LDSCs) or tendon derived stem cells (TDSCs), and MSCs from other sources, such as synovial fluid. MSC-based therapies have been applied to augment tendon and ligament healing in several different ways.” What we see is an explosion in research based on the concept that stem cell therapy may be very beneficial for tendon injuries such as those found in a De Quervain’s Tenosynovitis.
Do you have questions? Ask Dr. Darrow
Marc Darrow, MD., JD. is the medical director and founder of the Darrow Stem Cell Institute in Los Angeles, California. With over 23 years experience in regenerative medicine techniques and the treatment of thousands of patients, Dr. Darrow is considered a leading pioneer in the non-surgical treatment of degenerative Musculoskeletal Disorders and sports related injuries. Dr. Darrow has co-authored and continues to co-author leading edge medical research including the use of bone marrow derived stem cell therapy for shoulder, hip, knee and spinal disorders.
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
PHONE: (800) 300-9300 or 310-231-7000
Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.
Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.
References:
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
PHONE: (800) 300-9300 or 310-231-7000
Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.
1 Mangukiya HJ, Kale A, Mahajan NP, Ramteke U, Manna J. Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients. Musculoskeletal surgery. 2019 Dec;103(3):269-73.
2 Shafaee-Khanghah Y, Akbari H, Bagheri N. Prevalence of Carpal Tunnel Release as a Risk Factor of Trigger Finger. World Journal of Plastic Surgery. 2020 May;9(2):174.
3 Leong NL, Kator JL, Clemens TL, James A, Enamoto‐Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. Journal of Orthopaedic Research®. 2020 Jan;38(1):7-12.
4 Young SW, Young TW, MacDonald CW. Conservative management of De Quervain’s tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series. Physiotherapy Theory and Practice. 2020 Jun 1:1-0.