Asst. Professor Bronx VA / Mount Sinai Sch of Med Bronx, New York, United States
Case Diagnosis: Tamoxifen-Induced DeQuervain's Tenosynovitis
Case Description: A 42-year-old female with invasive ductal breast cancer was treated with cyclophosphamide, docetaxel, and radiotherapy. Tamoxifen was started after the completion of chemotherapy and radiation. Two weeks after initiation of tamoxifen the patient experienced progressive bilateral pain at the radial surface of the wrists causing functional impairment. Symptoms persisted for two months despite discontinuation of tamoxifen and pain was not improved with hand splinting. The patient was treated with isotonic 5% dextrose in water prolotherapy injections at the intersection of the first and second dorsal compartments of the wrist. The pain was completely relieved and sustained after a series of 4 prolotherapy injection sessions.
Discussions: Tenosynovial changes and arthralgias are known adverse effects of tamoxifen use that may result in discontinuation of therapy. The use of prolotherapy for tenosynovitis has been demonstrated in isolated case reports. We present a unique case of tamoxifen-induced bilateral tenosynovitis that improved with isotonic dextrose prolotherapy. Dextrose prolotherapy is believed to induce the expression of fibroblasts causing a release of growth factors and collagen deposition as well as having a rapid neurogenic effect on pain-producing c-fibers. In our case, the patient endorsed difficulty with activities of daily living including self-grooming, cleaning, cooking, bathroom hygiene, and dressing prior to treatment. At the completion of treatment sessions, the patient demonstrated improved function marked by a pain-free return to activities of daily living.
Conclusions: This is the first known case, to our knowledge, of the use of prolotherapy for the treatment of tamoxifen-induced tenosynovitis. Prolotherapy is a potential treatment for pain and improvement in function in the field of cancer rehabilitation. Prolotherapy is a relatively safe treatment with a low side effect profile that has the potential to improve functional outcomes as well as the adherence to cancer treatment regimens.