Summary
Introduction:
De Quervain's tenosynovitis (DQT) is a painful wrist condition that impairs daily activities. Corticosteroid (CS) injections are commonly used for symptom relief, but their effects may diminish over time. Platelet-rich plasma (PRP) has emerged as a regenerative alternative that promotes tissue healing rather than merely suppressing inflammation. This systematic review and limited meta-analysis compare the efficacy and safety of PRP versus CS injections in DQT. A limited meta-analysis was chosen due to the high heterogeneity between studies (I2 = 98.7%).
Methodology:
A comprehensive literature search identified six studies comparing PRP and CS injections. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Mayo Wrist Score (MWS). Statistical significance was analyzed, with follow-up durations ranging from 2 weeks to one year. The risk of bias was evaluated using Cochrane and ROBINS-I tools.
Results:
Both PRP and CS significantly reduced pain; however, PRP provided superior long-term relief. The VAS scores improved in all studies, with PRP showing significantly greater reduction at 6 months (p < 0.001). A study also found better QuickDASH-9 scores in PRP-treated patients (p < 0.01). The PRP had fewer complications than CS p=0.026, reinforcing its safety advantage.
Conclusion:
The PRP and CS effectively reduce pain, but preliminary evidence suggests PRP may offer longer-lasting symptom relief than corticosteroids; however, findings are limited by small sample sizes, study heterogeneity, and low certainty of evidence. Further high-quality trials with standardized PRP protocols are warranted.
Keywords: De Quervain's tenosynovitis, Platelet-rich plasma, Corticosteroid injection, Wrist pain, Regenerative therapy, Systematic review, Meta-analysis, Long-term outcomes
Introduction
De Quervain's tenosynovitis (DQT) is a painful condition affecting the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL), which are crucial for thumb movement, particularly during tasks such as handwriting [1]. The condition is characterized by pain, swelling, and restricted motion along the radial side of the wrist, progressively impairing hand function [2]. If left untreated, DQT can worsen over time, leading to significant functional limitations.
Epidemiological data indicate that DQT is more prevalent in women and tends to peak during the fourth and fifth decades of life [3]. Diagnosis primarily relies on clinical evaluation, with the Finkelstein and Eichhoff tests serving as key diagnostic maneuvers. These tests help differentiate DQT from other conditions affecting the wrist. Imaging modalities, including x-rays, ultrasound, and Magnetic Resonance Imagining, can further assist in ruling out alternative causes of pain, such as fractures or arthritis [4,5].
Conservative treatment remains the first-line approach for managing DQT, typically involving activity modification, ice therapy, physiotherapy, and nonsteroidal anti-inflammatory drugs (NSAIDs). When these measures fail to provide adequate relief, corticosteroid (CS) injections are widely used. However, corticosteroids are associated with complications such as pigmentary changes, tendon rupture, and post-injection pain flare [6,7,8,9,10,11,12,13,14].
Platelet-rich plasma (PRP) has recently emerged as a potential alternative, leveraging its regenerative properties to promote tissue healing. PRP delivers concentrated growth factors that accelerate repair processes while exhibiting anti-inflammatory effects similar to corticosteroids. Importantly, PRP is believed to have a lower incidence of adverse effects, making it an attractive option for managing DQT [6,7,8,9,10,11,12,13,14].
Methods
We conducted a thorough literature review in May 2024 using the terms’ de Quervain's tenosynovitis' and ‘platelet-rich plasma’ Appendix 1). We searched PubMed, Google Scholar, Ovid, and Web of Science databases to identify articles that met our inclusion criteria and were published with no time limits. Separately, 2 reviewers conducted a primary screening search, and the conflicts were resolved by a third party to find the studies that matched the search terms by title/abstract. All authors did further full-text screening. Studies describing platelet-rich plasma use for the treatment of DQT did not include consensus statements. Inclusions and exclusions were demonstrated using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) (Fig. 1). Using our search parameters, we identified 180 records from the searched databases. After removing 49 duplicates, 131 unique records underwent title and abstract screening. Of these, 122 records were excluded for not meeting the inclusion criteria. The remaining 9 full-text articles were assessed for eligibility. Three of these were excluded after full-text review (reasons: non-comparative design [n=2], insufficient outcome data [n=1]), resulting in 6 studies that met our inclusion criteria and were included in the final systematic review and meta-analysis). These comprised 3 randomized controlled trials (RCTs), 1 quasi-experimental study, 1 retrospective cohort study, and 1 descriptive case series.
Fig. 1.
The search results and selection procedure.
Fig. 2.
Forest plot showing VAS scores, PRP: platelet rich plasma, CS: corticosteroid, VAS: visual analog scale.
We searched PubMed, Google Scholar, Web of Science, and Ovid separately using customized Boolean syntax adapted to each platform. The final search was conducted on May 2024. Full search strategies are detailed in Appendix 1.
The published studies’ inclusion criteria included the following: Types of studies: randomized controlled trials, quasi-experimental studies, retrospective cohort studies, and descriptive case series. Studies with adult patients of both genders’ studies included adequate follow-up and documentation of the clinical picture. Comparative studies evaluating PRP against corticosteroid injection or other interventions for DQT.
The exclusion criteria for the studies include studies that did not include adequate, relevant clinical data or with a lack of follow-up. Studies with a high risk of bias or low quality based on the assessment of the Cochrane Risk of Bias tool for RCTs and the ROBINS-I tool for non-randomized studies. Studies other than the specified designs (RCTs, quasi-experimental, cohort, case series). Studies with incomplete clinical data. Non-comparative studies, reviews, consensus statements, and conference abstracts.
Population, intervention, comparison, and outcome (PICO) framework
Population: Adults diagnosed with DQT. Intervention: platelet rich plasma injection (PRP). Comparator: Corticosteroid injection. Outcome: Pain (Visual Analog Scale [VAS]), function (DASH, MWWS), complication rates, recurrence.
The Cochrane risk of bias (RoB) tool was used to evaluate randomized controlled trials. The risk of bias in non-randomized studies - of Interventions (ROBINS-I) tool was used to assess quasi-experimental and cohort studies. The Joanna Briggs Institute (JBI) critical appraisal checklist for case series was used for the descriptive case series. All data has been recorded on an Excel sheet for further data analysis using the latest version of Statistical Package for the Social Sciences (SPSS).
Data analysis
All available patients’ demographics have been recorded. The 2 primary outcomes recorded are pain measured with VAS score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score, which is a scale score ranging from 0 (no disability) to 100 (most severe disability). Follow-up of patients and a repeat of said scores will be at 4, 12, and 24 weeks. Statistical analysis was performed using SPSS version 28.0 (IBM Corp., Armonk, NY) and Review Manager 5.4 (Cochrane Collaboration). For meta-analysis, we used random-effects models due to anticipated clinical and methodological heterogeneity. Continuous outcomes (VAS, DASH, MWWS) were analyzed using mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics, with I2 > 50% indicating substantial heterogeneity. Subgroup analyses were planned based on study design, PRP type, and follow-up duration. Publication bias was assessed visually using funnel plots when ≥ 10 studies were available for an outcome. Statistical significance was set at p < 0.05. Publication bias could not be assessed using funnel plots or Egger's test, as fewer than 10 studies were included in the meta-analysis, which precludes reliable interpretation.
Results
A total of 6 studies met the inclusion criteria, comprising 3 randomized controlled trials (RCTs) [15,16,25], 1 quasi-experimental study [33], 1 descriptive case series [34], and 1 retrospective cohort study Sunil et al. [17]. Sample sizes ranged from 30 to 100 participants, with follow-up durations varying from 3 weeks to 1 year. The primary intervention across studies was platelet-rich plasma (PRP) injections, compared against corticosteroid (CS) injections, with 1 study including conservative management as a comparator.
Fig. 3.
Illustrates the comparative pain reduction outcomes, PRP: Platelet rich plasma, CS: Corticosteroid, VAS: Visual analog scale.
Study heterogeneity was notable due to differences in intervention protocols, sample sizes, and follow-up periods. Formal heterogeneity analysis was not conducted due to the variability in outcome reporting, but qualitative assessment suggests moderate heterogeneity across studies.
All 6 studies measured pain reduction using the VAS. The PRP demonstrated significant pain reduction across all studies, with long-term superiority over CS in most cases. The magnitude of pain reduction and statistical comparisons are summarized in Table 1.
Table 1.
Characteristics of included studies and participants.
| Author, year | Sample Size | Groups | Average age | Gender | Side involvement |
|---|---|---|---|---|---|
| Kumar et al. 2023 | n= 60 Group A= 30 Group B=30 | Group A: PRP Injection Group B: Corticosteroid | PRP: 35.83±8.48 cs: 37.80±6.44 | PRP: Male: 23.7% Female: 73.3% CS: Male: 33.3% Female: 66.7% | PRP: Right= 55.7% Left= 44.3 CS: Right= 76.7% Left= 23.3 |
| Khan et al. 2023 | n=96 Group A: 33 Group B: 31 Group C: 30 | Group A: platelet-rich plasma injection Group B: corticosteroid injection Group C: conservative management | PRP: 45.6 (±10.4) CS: 46.9 (±11.3) CM: 42.4 (±6.3) | PRP: Male: 12 (36.4) Female: 21 (63.6) CS: Male: 9 (29) Female: 22 (71) CM: Male: 7 (23.3) Female: 23 (76.7) | PRP: Right= 20(60.6) Left= 13 (39.4) CS: Right= 24 (77.4) Left= 7 (22.6) CM: Right= 18 (60) Left= 12 (40) |
| Ashour et al. 2024 | n=40 Group A: 20 Group B: 20 | Group A: PRP Injection Group B: Corticosteroid | PRP: 42.30 ± 12.03 CS: 44.50 ± 11.84 | PRP: Male: 4 (20.0%) Female: 16 (80.0%) CS: Male: 3 (15.0%) Female: 17 (85.0%) | PRP: Right= 15 (75) Left= 4 (20) Bilateral= 1(5) CS: Right= 13 (65) Left= 7(35) |
| Al Ardhi 2017 | n= 30 | PRP injection | Not mentioned | Not mentioned | Not mentioned |
| Wani et al. 2020 | n= 100 | PRP combined with oral NSAID (Naproxen 500 mg twice daily) | 41.26±11.26 | Male: 57 Female: 43 | Not mentioned |
| Sunil et al. 2024 | n= 58 Group A: 29 Group B: 29 | Group A: PRP Injection Group B: Corticosteroid | 43.3±8.6 | PRP: Male: 51.7% Female: 48.3% CS: Male: 65.5% Female: 34.5% | Not mentioned |
PRP: platelet-rich plasma, NSAID: non-steroidal anti-inflammatory drag, CS: corticosteroid, CM: male number.
Table 2.
Comparison of VAS scores.
| Author, year | Outcome measure | n (PRP) | Pre value mean±SD | Post value mean±SD | N (CS) | Pre value mean±SD | Post value mean±SD |
|---|---|---|---|---|---|---|---|
| Kumar et al. 2023 | VAS | 30 | 6.73 ±1.44 | 0.40 ± 0.62 | 30 | 6.53 ± 1.48 | 0.47 ± 0.78 |
| Khan et al. 2023 | VAS | 33 | 7.8 ± 0.8 | 1.7 ± 0.7 | 31 | 7.9 ± 0.6 | 2.5 ± 0.6 |
| Ashour et al. 2024 | VAS | 20 | 7.40 ± 1.23 | 1.30 ± 1.63 | 20 | 7.35 ± 1.23 | 5.55 ± 1.57 |
| Al Ardhi 2017 | VAS | 30 | 5.92 ± 0.76 | 2.11 ± 1.0 | |||
| Wani et al. 2020 | VAS | 100 | - | - | - | - | |
| Sunil et al. 2024 | VAS | 29 | 6.9 ± 0.772 | 1.14 ± 0.441 | 29 | 6.69± 0.772 | 1.66 ± 0.441 |
In the Wani et al. study, they did not mention VAS score pre and post values in mean and SD; they used percentages for each score instead. VAS: visual analog scale, PRP: platelet-rich plasma. SD: standard deviation, CS: corticosteroid.
Kumar et al. [25] reported a mean VAS reduction of 6.33 points for PRP (95% CI: 5.8–6.8) and 6.06 points for CS (95% CI: 5.6–6.5), with no statistically significant difference between groups (p = 0.001, d = 0.78). Similarly, Khan et al. [15] demonstrated greater pain reduction with PRP (7.8 ± 0.8 to 1.7 ± 0.7) than with CS (7.9 ± 0.6 to 2.5 ± 0.6) at 6 months (p < 0.001, d = 0.85). Ashour et al. [16] found that PRP significantly outperformed CS, with VAS scores decreasing from 7.40 ± 1.23 to 1.30 ± 1.63, whereas CS patients had a smaller reduction (7.35 ± 1.23 to 5.55 ± 1.57, p < 0.01, d = 1.12).
Two studies did not provide a direct PRP-CS comparison. Al Ardhi [33] reported a statistically significant reduction in VAS following PRP treatment (p < 0.05), while Wani et al. [34] noted that 85% of PRP-treated patients experienced pain relief, though precise VAS scores were unavailable. Sunil et al. [17] demonstrated PRP's superiority at one month (p = 0.007) and 6 months (p = 0.004), with a mean VAS reduction of 5.76 points compared to 5.03 points for CS.
Two studies evaluated functional improvement using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and Mayo Wrist Work Score (MWWS). Kumar et al. [25] reported significant improvement in both measures across PRP and CS groups, but no statistically significant difference was observed between treatments. Similarly, Sunil et al. [17] found no significant differences in DASH and MWWS scores at any follow-up time points. These findings indicate that while PRP offers superior pain reduction, functional outcomes are comparable between PRP and CS.
The PRP and CS demonstrated similar short-term pain relief at follow-up of 2 weeks to 3 months. However, at 6 months and beyond, PRP consistently showed greater and more sustained symptom relief. Both Khan et al. [15] and Ashour et al. [16] reported significantly lower VAS scores in PRP groups compared to CS at 6 months. Kumar et al. [25], the only study with 1-year follow-up, found no major differences between PRP and CS, suggesting that CS may provide adequate early pain relief, whereas PRP confers longer-term benefits.
Limited subgroup data were available, though Khan et al. [15] reported that patients under 40 years experienced greater pain relief with PRP than those over 40 (p = 0.03). No studies provided sex-stratified efficacy data, despite the fact that more than 65% of participants across studies were female, consistent with the epidemiology of DQT. Additionally, PRP appeared more effective in patients with higher baseline VAS scores (> 7.5), but statistical confirmation of this trend is required in future studies.
Table 3.
Risk of bias assessment for RCTs (Cochrane RoB 2.0 Tool).
| Study | Random sequence generation | Allocation concealment | Blinding of participants | Blinding of outcome assessors | Incomplete outcome data | Selective reporting | Other bias | Overall risk |
|---|---|---|---|---|---|---|---|---|
| Kumar et al. 2023 | Low | Low | High | Low | Low | Low | Low | Some concerns |
| Khan et al. 2023 | Low | Unclear | High | Low | Low | Low | Low | Some concerns |
| Ashour et al. 2024 | Low | Low | High | Low | Low | Low | Low | Some concerns |
Table 4.
Risk of bias assessment for non-randomized studies (ROBINS-I).
| Study | Bias due to confounding | Bias in selection | Bias in classification | Bias due to deviations | Bias due to missing Data | Bias in measurement | Bias in selection of reported results | Overall risk |
|---|---|---|---|---|---|---|---|---|
| Al Ardhi, 2017 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
| Wani et al., 2021 | Serious | Serious | Low | Low | Low | Low | Low | Serious |
| Sunil et al., 2024 | Moderate | Moderate | Low | Low | Low | Low | Low | Moderate |
The PRP was well tolerated across all studies and was associated with fewer complications compared to CS. Kumar et al. [25] reported significantly fewer adverse effects in the PRP group compared to the CS group (p = 0.026). Ashour et al. [16] found no significant differences in complication rates between PRP and CS groups. The most frequently reported corticosteroid-related adverse effects included transient pain flare-ups, local tissue atrophy, and symptom recurrence within 6 months. These findings suggest that PRP may be a safer alternative for long-term symptom management.
Table 5.
JBI critical appraisal for case series (Wani et al., 2021).
| Criteria | Yes | No | Unclear | Not Applicable |
|---|---|---|---|---|
| Were there clear criteria for inclusion? | ✓ | |||
| Was the condition measured reliably? | ✓ | |||
| Were valid methods used for identification? | ✓ | |||
| Did the study include consecutive patients? | ✓ | |||
| Was complete inclusion of participants? | ✓ | |||
| Was reporting of demographics complete? | ✓ | |||
| Was reporting of clinical information complete? | ✓ | |||
| Were outcomes/follow-up results clear? | ✓ | |||
| Was reporting of presenting site(s) complete? | ✓ | |||
| Was statistical analysis appropriate? | ✓ |
JBI: Joanna Briggs Institute.
Table 6.
Complete outcome data extraction from included studies.
| Author, Year | Design | Groups (N) | Follow-up | Primary Outcomes | Secondary Outcomes | Complications |
|---|---|---|---|---|---|---|
| Kumar et al. 2023 | RCT | PRP (30) vs CS (30) | 2w, 6w, 12w, 24w, 1y | VAS, DASH, MWWS | Patient satisfaction | PRP: 3/30 (10%) CS: 8/30 (27%) p = 0.026 |
| Khan et al. 2023 | RCT | PRP (33) vs CS (31) vs CM (30) | 6m | VAS, QuickDASH | Return to work | Pain flare: PRP: 2, CS: 7 |
| Ashour et al. 2024 | RCT | PRP (20) vs CS (20) | 6m | VAS, QuickDASH-9 | Grip strength | No significant difference |
| Al Ardhi 2017 | Quasi-exp | PRP (30) | 3w | VAS | Clinical improvement | Not reported |
| Wani et al. 2021 | Case series | PRP+NSAID (100) | 6m | VAS (% improvement) | Functional recovery | Minimal (5% transient pain) |
| Sunil et al. 2024 | Retrospective cohort | PRP (29) vs CS (29) | 1m, 3m, 6m | VAS, DASH, MWWS | Recurrence rate | PRP: 2/29, CS: 5/29 |
RCT: randomized controlled trials, VAS: visual analog scale, PRP: platelet-rich plasma, SD: standard deviation, CS: corticosteroid, MWWS: mayo wrist work score, DASH: disabilities of the arm, shoulder, and hand.
Table 7.
Data of forest plot of VAS scores at 6 months.
| Study | PRP Group (Mean±SD) | CS Group (Mean±SD) | Mean Difference (95% CI) | Weight |
|---|---|---|---|---|
| Kumar et al. 2023 | 0.40 ± 0.62 | 0.47 ± 0.78 | -0.07 (-0.41, 0.27) | 28.5% |
| Khan et al. 2023 | 1.70 ± 0.70 | 2.50 ± 0.60 | −0.80 (−1.12, −0.48) | 30.2% |
| Ashour et al. 2024 | 1.30 ± 1.63 | 5.55 ± 1.57 | −4.25 (−5.24, −3.26) | 15.8% |
| Sunil et al. 2024 | 1.14 ± 0.44 | 1.66 ± 0.44 | −0.52 (−0.75, −0.29) | 25.5% |
| Pooled Effect | −1.41 (−2.85, 0.03) | 100% |
I2 = 98.7% (High heterogeneity), Tau2 = 2.15, Chi2 = 231.45, df = 3 (p < 0.001). PRP: Platelet-rich plasma. CS: corticosteroid.
Risk of bias was assessed using the Cochrane Risk of Bias (RoB) tool for RCTs and the ROBINS-I tool for non-randomized studies. Studies by Kumar et al. [25], Khan et al. [15], and Ashour et al. [16] had low-to-moderate risk of bias, though none implemented participant blinding, increasing the risk of performance bias. The non-randomized studies by Sunil et al. [15], Al Ardhi [33], and Wani et al. [34] had moderate risk of bias due to potential confounding factors. Differences in intervention protocols and follow-up durations limit direct comparability between studies, highlighting the need for further high-quality trials.
These findings support PRP as a viable first-line treatment for DQT, particularly for patients seeking long-term symptom relief and lower recurrence rates. While CS remains an effective short-term intervention, its use is associated with higher recurrence rates and a greater risk of adverse effects. The PRP may be particularly beneficial for younger patients and those with severe baseline symptoms. Future research should focus on cost-effectiveness analyses, combination therapies, and the standardization of PRP protocols.
Discussion
De Quervain's tenosynovitis is the most common cause of wrist pain, particularly in patients with repetitive thumb movement [35]. The mainstay of nonoperative treatment is corticosteroid injection, which rapidly relieves pain due to its potent anti-inflammatory effect. Corticosteroid injection provides significant pain relief in DQT, with clinical benefit often lasting 6 to 12 months, although recurrence is most likely within the first 6 months. Repeated injections may be considered in some patients, but concerns have been raised about potential tendon weakening or degeneration, and long-term efficacy remains uncertain [36]. Platelet-rich plasma (PRP) has increasingly been applied as a regenerative therapy agent that initiates tissue regeneration rather than merely preventing inflammation [37]. The present systematic review compares the efficacy of platelet-rich plasma (PRP) and corticosteroid (CS) injections and suggests that PRP may provide more sustained pain relief, improved functional outcomes, and fewer complications but also acknowledges that this review includes low-quality evidence and uncertainty based on the available literature. The pooled analysis must be interpreted with caution, given the substantial heterogeneity (I2 = 98.7%) and clinical diversity of included studies. These findings should be viewed as exploratory rather than confirmatory.
The PRP is prepared from autologous venous blood using single- or double-spin centrifugation methods, yielding either leukocyte-rich or leukocyte-poor formulations. Typically, 2–3 mL of PRP is injected into the first dorsal compartment sheath, often under ultrasound guidance to ensure accurate delivery, particularly when anatomical variations such as a separate EPB sub-compartment are present. In most studies, a single injection is administered, though repeat injections may be considered after several weeks if symptoms persist [37]. The therapeutic rationale is regenerative: platelet α-granules release growth factors, including PDGF, VEGF, and TGF-β, which stimulate tenocyte proliferation, angiogenesis, and extracellular matrix synthesis while modulating local inflammation.
Table 8.
DASH and MWWS scores across studies.
| Study | Group | Time Point | DASH Score (Mean±SD) | MWWS Score (Mean±SD) | P -value |
|---|---|---|---|---|---|
| Kumar et al. 2023 | PRP | Baseline | 68.4 ± 12.3 | 45.2 ± 8.7 | - |
| 6 months | 12.1 ± 4.5 | 85.6 ± 6.3 | - | ||
| CS | Baseline | 67.8 ± 11.9 | 46.1 ± 7.9 | - | |
| 6 months | 13.5 ± 5.1 | 83.4 ± 7.1 | - | ||
| Between-group p | 0.42 | 0.38 | |||
| Ashour et al. 2024 | PRP | Baseline | QuickDASH: 75.3 ± 10.2 | - | - |
| 6 months | QuickDASH: 15.6 ± 8.4 | - | - | ||
| CS | Baseline | QuickDASH: 74.8 ± 9.7 | - | - | |
| 6 months | QuickDASH: 45.2 ± 12.1 | - | - | ||
| Between-group p | <0.01 | ||||
| Sunil et al. 2024 | PRP | Baseline | 66.7 ± 10.5 | 48.3 ± 7.2 | - |
| 6 months | 14.2 ± 6.3 | 86.7 ± 5.8 | - | ||
| CS | Baseline | 65.9 ± 11.2 | 47.6 ± 6.9 | - | |
| 6 months | 16.8 ± 7.1 | 82.4 ± 6.5 | - | ||
| Between-group p | 0.35 | 0.28 |
MWWS: mayo wrist work score, DASH: disabilities of the arm, shoulder, and hand SD: standard deviation.
Table 9.
PRP preparation and injection protocols.
| Study | PRP Type | Centrifugation Protocol | Activation Method | Platelet Concentration | Injection Volume | Guidance | Number of Injections |
|---|---|---|---|---|---|---|---|
| Kumar et al. 2023 | LP-PRP | Double spin | Calcium chloride | 3-5× baseline | 3 mL | Ultrasound | Single |
| Khan et al. 2023 | LR-PRP | Single spin | Autologous thrombin | 4-6× baseline | 2.5 mL | Ultrasound | Single |
| Ashour et al. 2024 | LP-PRP | Double spin | Calcium gluconate | 3-4× baseline | 2 mL | Ultrasound | Single |
| Al Ardhi 2017 | Not specified | Single spin | Not specified | Not specified | 2 mL | Anatomical landmark | Single |
| Wani et al. 2021 | LR-PRP | Double spin | Calcium chloride | 5-7× baseline | 3 mL | Ultrasound | Single |
| Sunil et al. 2024 | LP-PRP | Double spin | Calcium chloride | 3-5× baseline | 2.5 mL | Ultrasound | Single |
LP-PRP: leukocyte-poor platelet rich plasma, LR: leukocyte-rich, PRP: platelet rich plasma.
9. Quality Assessment Summary.
The most commonly used preparation is triamcinolone acetonide, administered at a dose of 10 mg (1 mL of 10 mg/mL), sometimes combined with a local anesthetic for a total volume of 1–2 mL. Injections are typically directed into the tendon sheath of the abductor pollicis longus and extensor pollicis brevis, with ultrasound guidance improving accuracy and outcomes, especially in the presence of septations [38]. Most patients receive 1 injection, with a second injection considered after 3–6 weeks if only partial relief is achieved; more than 2 injections in the same site are generally avoided [39]. The mechanism of action is primarily through potent local anti-inflammatory effects, providing rapid pain relief that may persist for up to 6-12 months in responders.
The review confirms that CS and PRP significantly reduce pain in DQT, though PRP has prolonged effects. Some of the aforementioned studies Khan et al. [15], Ashour et al. [16], and Sunil et al. [17] have found statistically lower 6-month follow-up Visual Analog Scale (VAS) scores in PRP-treated patients compared to corticosteroid-treated patients. This agrees with current evidence in tendinopathy, where PRP has been shown to cause long-term healing, whereas corticosteroids provide only short-term relief [18,19].
The long-term efficacy of PRP is due to the release of bioactive growth factors such as platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-β), which stimulate fibroblast proliferation and extracellular matrix remodeling Frangogiannis et al. [20]. Corticosteroids, however, inhibit inflammatory mediators such as prostaglandins and cytokines Liberman et al. [21] but do not eliminate the degenerative changes of chronic DQT. This may explain why corticosteroid injections have been associated with higher recurrence rates [7,22].
The PRP's advantages extend beyond pain relief to functional recovery. Ashour et al. [16] illustrated increased QuickDASH-9 scores in the PRP group compared to the CS group at 6 months (p < 0.01), with more hand and wrist function recovered. This is evidenced in lateral epicondylitis and patellar tendinopathy, where long-term functional gain was observed with PRP injections versus corticosteroid injections [23,24]. Because DQT significantly impairs activities of daily living, such as grip and pinch, the functional advantage of PRP in the long term speaks volumes regarding its clinical relevance.
Although statistically significant differences in VAS and DASH scores were observed, it remains unclear whether these exceed the minimal clinically important difference (MCID). Prior literature suggests an MCID of ~1.5–2.0 for VAS and ~10–15 for DASH; only some studies met this threshold, indicating potential clinical relevance but requiring confirmation.
The PRP also had a superior safety profile compared to corticosteroids. Kumar et al. [25] previously reported that patients treated with PRP had significantly fewer complications (p = 0.026). The most common side effects of corticosteroids reported were pain flare, transient local tissue loss, and recurrence of symptoms at 6 months [15]. These findings align with earlier studies indicating that chronic steroid injections can cause degeneration of collagen scaffolds, making the tendon prone to rupture Coombes et al. [26].
The reduced likelihood of complications with PRP stems from its autologous origin, which lowers the risk of triggering immune reactions. This advantage has been noted in other musculoskeletal conditions, including Achilles tendinopathy and rotator cuff injury, where PRP was less deleterious than corticosteroids [27,28]. The significance of this review reflects the need for long-term safety considerations in determining the best treatment for DQT, particularly for high-risk patients in terms of tendon degeneration.
Despite its promising findings, this review has certain limitations that should be acknowledged. The included studies were heterogeneous in methodology, sample size, and PRP preparation protocols, resulting in heterogeneity of results. Study PRP preparations varied visibly in platelet concentration and activation method, potentially affecting clinical outcomes. This variability is common in PRP studies, where preparation differences can significantly influence the material's biological activity upon injection [18,29]. Standardized PRP procedures must be established to facilitate reproducibility and comparability of results in future studies.
Additionally, while RCTs provided good-quality evidence, some of the reviewed studies were not randomized, introducing potential selection bias. No participant blinding was performed in any of the included studies, increasing the risk of performance bias. These methodological flaws align with earlier systematic reviews of PRP, where poor blinding has been a primary source of bias in determining treatment outcomes [30]. The findings should be viewed as exploratory rather than confirmatory. Future studies should prioritize high-quality, double-blinded RCTs with comparable follow-up durations to strengthen PRP's evidence base for DQT.
Table 10.
Overall quality of evidence (GRADE approach).
| Outcome | Number of Studies | Study Designs | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Quality of Evidence |
|---|---|---|---|---|---|---|---|---|
| Pain reduction (VAS) | 6 | 3 RCTs, 3 obs | Serious1 | Serious2 | Not serious | Not serious | Undetected | ⨁⨁◯◯ LOW |
| Functional improvement (DASH) | 3 | 2 RCTs, 1 obs | Serious1 | Serious2 | Not serious | Serious3 | Undetected | ⨁ ◯ ◯ ◯ VERY LOW |
| Complications | 4 | 3 RCTs, 1 obs | Serious1 | Not serious | Not serious | Serious3 | Undetected | ⨁ ⨁ ◯ ◯ LOW |
| Long-term efficacy (≥6 months) | 4 | 3 RCTs, 1 obs | Serious1 | Serious2 | Not serious | Not serious | Undetected | ⨁ ⨁ ◯ ◯ LOW |
Most studies had high risk of performance bias due to lack of blinding.
High statistical heterogeneity (I2>75%).
Wide confidence intervals or small sample sizes.
RCT: randomized controlled trials. VAS: Visual Analog Scale. DASH: Disabilities of the Arm, Shoulder, and Hand.
Clinical implications and future directions
Existing evidence suggests that PRP is a promising alternative to corticosteroids for patients seeking long-term symptom relief and functional recovery in DQT. With its good safety profile, low recurrence rate, and durability, PRP could be considered a first-line treatment, particularly for patients unresponsive to initial conservative management.
However, cost remains a concern. While PRP has demonstrated superior long-term effectiveness, its higher cost compared to corticosteroids may limit access in some healthcare systems [31]. Follow-up studies should assess PRP's cost-utility and explore combination therapies to further optimize treatment. More studies are needed to evaluate PRP's efficacy in diverse patient populations.
Khan et al. [15] also found that younger patients under 40 years of age experienced greater pain relief with PRP compared to those over 40 (p = 0.03), suggesting differential responsiveness based on age. Similar trends have been observed in other PRP trials, where younger patients exhibited greater regenerative potential [32]. Future research should investigate the influence of age, disease severity, and baseline symptom burden on PRP's efficacy in DQT.
Study design and limitations
We conducted a PRISMA-guided systematic review including RCTs and observational studies comparing PRP with corticosteroid injection for DQT. Primary outcomes were pain (VAS) and function (DASH/MWWS) at prespecified follow-ups; risk of bias was assessed using Cochrane tools for randomized trials and ROBINS-I for non-randomized studies. Limitations include heterogeneity in PRP preparation (spin protocol, leukocyte content, activation), injection technique, and follow-up duration, which may influence treatment effects and reduce comparability. Several studies had modest sample sizes and lacked participant blinding, increasing performance bias. Some outcomes were incompletely reported, limiting pooled analyses. Finally, few studies stratified by age, sex, or symptom duration, precluding robust subgroup inferences. Future trials should standardize PRP protocols, use ultrasound guidance consistently, ensure adequate power with longer follow-up, and prespecify core outcomes to enhance synthesis and clinical translation.
In conclusion, this systematic review suggests that both platelet-rich plasma and corticosteroid injections are associated with pain reduction in DQT. While some included studies reported longer-lasting symptom relief and fewer adverse effects with PRP, the overall strength of evidence remains limited. The small number of studies, variation in study design and quality, and substantial heterogeneity in PRP preparation protocols preclude definitive clinical recommendations. As such, PRP cannot currently be considered a clearly superior alternative to CS. Further high-quality, adequately powered randomized controlled trials with standardized PRP protocols are necessary to clarify its clinical utility and cost-effectiveness in this setting.
Acknowledgment
The authors would like to thank Wordvice for the English language editing.
Disclosure
The authors utilized AI-assisted technology (DeepSeek AI) during the initial drafting and editing of the manuscript to improve language and grammar. All data collection, analysis, interpretation, and the final synthesis of the manuscript content are the sole responsibility of the authors. The correctness and accuracy of the manuscript are the responsibility of the authors. No AI tool was used for image creation, data collection, or data analysis. The manuscript, in its entirety or in essence, either has not been previously published in any language, partially or fully, in any website or printed journal.
Appendix 1: Complete search strategy
PubMed (last searched May 22, 2024): (“De Quervain Disease”[MeSH] OR “tenosynovitis” OR “radial styloid tenosynovitis”) AND (“Platelet-Rich Plasma”[MeSH] OR “PRP”).
Web of Science: TS=(“De Quervain's tenosynovitis”) AND TS=(“Platelet-rich plasma”).
Google Scholar: “De Quervain” AND (“PRP” OR “platelet-rich plasma”) –intitle:review.
Gray literature: No gray literature or conference abstracts were included due to limited access.
Filters: Humans, English.
Contributor Information
Abdullah W. Abumadian, Email: 2010210@ibnsina.edu.sa.
Mohanad I. Binibrahim, Email: Binibrahimmohandi@gmail.com.
Abdurrahman H. Sultan, Email: Abdulrahman21orhtomed@gmail.com.
Mohammed A. Addas, Email: Addas.mohammed123@gmail.com.
Hattan Y. Bamagaus, Email: Hattanbamagaus@gmail.com.
Sultan K. Alhaddad, Email: Sultanhaddad48@gmail.com.
Motasem O. Bamabad, Email: Msalehbamabad@stu.kau.edu.sa.
Bayan A. Ghalimah, Email: Bghalimah@kau.edu.sa.
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