Attending Veterans Affairs Hospital Miami, Florida, United States
Case Diagnosis: Successful ultrasound guided leukocyte-poor PRP injection for bilateral first carpometacarpal pain related to osteoarthritis
Case Description: 67-year-old female army veteran with worsening bilateral thumb-base pain and decreased hand function interfering with ADLs. Pain was refractory to therapy, hand splinting, topical/oral NSAIDs, and corticosteroid injections. Orthopedics recommended surgery, however patient declined. Exam notable for bilateral first carpometacarpal (CMC) joint tenderness, restricted ROM and strength, and positive CMC grind test. Imaging was consistent with moderate to severe bilateral first CMC osteoarthritis. We proceeded with ultrasound-guided platelet rich plasma injections. Clinic protocol was followed, resulting in autologous 1-1.5cc of PRP injected into each CMC joint without complications. Post-injection care included relative rest, splinting, ice, and one week of NSAID avoidance. At post-injection telephone follow-up, patient reported 30% improvement in hand function, improved ROM, less pain with activity, resolved pain at rest, and no adverse events.
Discussion: First carpometacarpal joint osteoarthritis is relatively common and affects quality of life. Osteoarthritis is one of many musculoskeletal conditions platelet-rich plasma (PRP) is being utilized to treat. PRP is an autologous mixture of growth factors and platelets created through whole blood centrifugation used to promote tissue regeneration. Despite the high prevalence of the disease and increasing availability of PRP, limited data exists on use of PRP for first digit CMC osteoarthritis. Our case is of an Army veteran with chronic moderate to severe bilateral first CMC osteoarthritis whose pain had been refractory to conservative measures. She underwent bilateral CMC ultrasound-guided PRP injection therapy resulting in decreased pain, improved ROM, function and satisfaction with no reported adverse events.
Conclusions: More research is needed, however, this case demonstrates that Leukocyte Poor-PRP injections may be a valuable and safe intervention for patients with chronic refractory first CMC pain secondary to osteoarthritis. Furthermore, given the mechanism of PRP, it may be a more long-term solution.