Working Diagnosis:
Carpal tunnel syndrome secondary to flexor digitorum superficialis/profundus tendinosis

Treatment:
Diagnostic/therapeutic intra-articular corticosteroid injection
Intra-articular/peri-tendinous dextrose prolotherapy every 4 weeks for 3 months
Eccentric exercises

Outcome:
There was 100% relief of wrist pain with corticosteroid injection but forearm pain was unchanged. After 6 weeks the ventral wrist pain returned to baseline. Series of 3 dextrose prolotherapy injections were performed every 4 weeks. These injections along with eccentric exercises resulted in complete resolution of pain/radiating symptoms within the forearm and wrist after 3 month period of time.

Author's Comments:
-Carpal tunnel syndrome is not uncommon but often the underlying cause is unknown. Consider wrist flexor tendinosis as a primary contributor in the differential in a patient who also has forearm pain.

-Wrist flexion increases pressure within the carpal tunnel 8-fold.

-Repetitive flexion in the wrist, particularly in the setting of poor tendon stabilization, significantly increase the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel.

-Underlying factor in this case is likely overuse wrist flexor tendinopathy.

-Although evidence is limited, it is thought that dextrose prolotherapy stimulates the body to repair weak/injured areas of the body. In this case of prolonged chronic wrist/forearm pain dextrose prolotherapy in combination with eccentric rehabilitation provided significant benefit.

-The resolution of carpal tunnel syndrome in this case is likely due to decreased flexor tendon laxity and improved stabilization.

-Although an isolated case, it seems dextrose prolotherapy was particularly beneficial and one of the primary sources of improvement in pain, particularly given she had undergone eccentric rehab and other conservative occupational therapies multiple times in the past.

-Further randomized clinical trials would be beneficial to further elucidate the efficacy of dextrose prolotherapy in similar cases.

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