A Comparative Study for Different Types of Thumb Base Osteoarthritis Injections: A Randomized Controlled Interventional Study

Ortop Traumatol Rehabil. 2020 Dec 31;22(6):447-454. doi: 10.5604/01.3001.0014.6055.

Abstract

Background: Base of the thumb osteoarthritis (OA) represents a challenge to clinicians due to limited efficient treatment options. Local injection treatment is a good choice for its low systemic side effects and rapid improvement. We conducted our study to compare the effectiveness of Platelet-Rich Plasma (PRP) versus hyaluronic acid injection (HA) versus corticosteroids in thumb carpometacarpal(CMC) joint osteoarthritis based on clinical and functional outcome measures.

Material and methods: 45 patients with thumb CMC OA, assessed by palpation for joint tenderness grading, Provocative tests (Grind test and Lever test), VAS for pain, AUSCAN score for hand function, grip and pinch strength. Patients were randomly divided into three equal groups, Group 1 received an intra-articular PRP injection. Group 2 received an HA injection, and Group 3 a corticosteroid injection. Re-evaluation was done at 4 and 12 weeks.

Results: All groups showed a significant improvement after 4 weeks regarding VAS, tenderness grading, AUSCAN score, grip and pinch strength in comparison to before injection. However, these improvements were not sustained for the PRP and steroid groups after 12 weeks, when there was a deterioration in the AUSCAN score, highly statistically increase in VAS and decrease in grip & pinch strength, while the HA group showed a highly statistically significant improvement at 12 weeks on all items evaluated.

Conclusion: 1. The 3 types of injection (PRP, HA, steroids) produced good results in thumb base OA with re-gard to improving pain and hand function, but only HA had a long-lasting effect and best results for pain and function. 2. The limitations in our study may be the follow-up period which needs to be longer to show how long the effect will last with HA.

Keywords: PRP; hyaluronic acid; intra-articular injection; osteoarthritis; steroid; thumb CMC.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Carpometacarpal Joints / drug effects*
  • Egypt
  • Female
  • Follow-Up Studies
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / therapeutic use*
  • Injections, Intra-Articular*
  • Male
  • Middle Aged
  • Osteoarthritis / drug therapy*
  • Pain / drug therapy*
  • Platelet-Rich Plasma*
  • Thumb / physiopathology*
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Hyaluronic Acid