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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 35  |  Issue : 2  |  Page : 166-168

A case report on efficacy of platelet-rich plasma therapy in avoiding surgical intervention for trapeziometacarpal joint osteoarthritis


1 Epione Center for Pain Relief and Beyond, Hyderabad, Telangana, India
2 Epione Pain Management Center, Hyderabad, Telangana, India

Date of Submission05-Oct-2020
Date of Decision27-May-2021
Date of Acceptance22-Jun-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Minal Chandra
Flat 301, Suma Splendor Apartments, Somajiguda, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_139_20

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  Abstract 


Osteoarthritis of the first carpometacarpal joint also called as trapeziometacarpal joint is the most common of all five carpometacarpal joints to undergo degeneration. The patient suffers with chronic pain, tenderness, stiffness of joint, and sometimes, even deformity can be seen in long-standing cases. Due to limited treatment options, patients have to suffer with side effects of pain killers or may have to undergo surgical intervention, but intra-articular joint injections and platelet-rich plasma therapy have been proven efficacious in providing good pain relief.

Keywords: First carpometacarpal joint, osteoarthritis, platelet-rich plasma therapy, trapeziometacarpal joint


How to cite this article:
Chandra M, Dara S, Reddy KK, Varma R. A case report on efficacy of platelet-rich plasma therapy in avoiding surgical intervention for trapeziometacarpal joint osteoarthritis. Indian J Pain 2021;35:166-8

How to cite this URL:
Chandra M, Dara S, Reddy KK, Varma R. A case report on efficacy of platelet-rich plasma therapy in avoiding surgical intervention for trapeziometacarpal joint osteoarthritis. Indian J Pain [serial online] 2021 [cited 2021 Nov 30];35:166-8. Available from: https://www.indianjpain.org/text.asp?2021/35/2/166/325200




  Introduction Top


Osteoarthritis is a degenerative condition and one of the common causes of disability. Although osteoarthritis of big joints is more common than the small joints such as carpometacarpal joints, the disability remains the same. The pathological damage happening in osteoarthritic process is the articular cartilage damage, leading to joint space reduction, these all leading to alteration in the joint environment which eventually involves the synovial tissue, thereby stimulating the nociceptors present within causing pain. Eventually, there starts compensatory repair mechanism with the development of osteophytes and sclerotic changes at bony margins.[1],[2]

Typical Treatment modalities in the past for the same conditions like conservative management in the form of physical therapies and splints, pharmacotherapy, steroids shot, viscosupplementation have provided only short-term symptomatic relief. For permanent treatment, surgical options have been looked upon and have given good clinical results.[3]

Literatures proving the role of platelet-rich plasma (PRP) therapy as an alternative permanent treatment are available. PRP therapy is a preparation of autologous blood containing concentrated platelets enriched with the growth factors helping in the regeneration of damaged tissue, thereby maintaining the tissue homeostasis by and coagulation responses of the body such as chondrocyte apoptosis inhibition, bone and vessel remodeling, inflammation modulation, and collagen synthesis,[4],[5],[6] thereby repairing and regenerating the damaged joint tissue preventing further damage progression and decreasing the pain.


  Case Report Top


After having taken written informed consent for reporting the case, we attempt to report this case of a 48-year-old postmenopausal female presenting to our pain management clinic with pain of base of thumb on both sides for 5 years associated with difficulty to pinch and associated tenderness at base of thumb and the thumb was kept in adduction. The pain was progressively increasing, and daily activities such as holding an object were becoming difficult. The radiological finding of X-ray showed Grade 2 osteoarthritis of the first carpometacarpal joint according to Eaton and Littler classification as seen in [Figure 1]. The visual analogue scale (VAS) score was 8/10, and pinch and grip were reduced to 3. The provocation grind test for pinching and gripping was positive. The patient was on multiple pharmacological treatment and has received steroid injection for the same in the past for the same pain with short-term mild pain relief. The patient was explained about the role of PRP therapy, and two sittings of PRP therapy for 2 weeks apart were planned. The patient was checked for adequate platelet count, and the procedure was planned as a daycare procedure. On the day of the procedure, the patient was counseled about the procedure, and written informed consent was taken; 18 ml of venous blood was collected from antecubital vein in 20 ml of syringe with 2 ml of anticoagulant. Blood was transferred into a commercially available kit for double centrifugation. After double centrifugation was completed, the patient was shifted to operation theater. Intravenous catheter 18G, routine monitoring for noninvasive blood pressure, heart rate, SpO2, and electrocardiogram were secured. The patient was put in supine position with hand in abduction under fluoroscopic guidance first carpalmetacarpal joint was identified as seen in [Figure 2], and 2 ml of PRP was injected using 18G needle. The patient was stable and shifted into recovery room. The second sitting of PRP therapy was given in the similar manner after 2 weeks. The patient was called for follow-up at 1 month, 3 months, and 6 months. The VAS score has decreased at 1 month, and there was no pain at 6 months. The pinch and grip have also increased. There was no tenderness at base of thumb during the follow-ups.
Figure 1: Needle entry in sclerosed first MCP joint

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Figure 2: Needle into the first MCP

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  Discussion Top


The first carpometacarpal joint formed between trapezium and first metacarpal bone is a saddle joint unlike other carpometacarpal joints giving it a concave-convex surface and allowing for movements in all directions allowing movements such as flexion, extension, abduction, adduction, opposition, reposition, and circumduction. This joint is prone for degenerative changes and is only the second joint in the hand to get prone for arthritic changes after DIP (Distal Interphalangeal Joint) joint.[7]

Due to instability of the joint and repetitive movements in this joint makes it more prone for degeneration and arthritic changes.

The palmar beak ligament surrounding the joint is prone for laxity due to which these changes occur, leading to the two bony surfaces rubbing against each other. The rubbing of the two surfaces against each other leads to the generation of inflammation in the synovium, leading to synovitis and also degeneration of the cartilage ultimately, leading to wearing off the cartilage and end results in formation of osteophytes and subchondral sclerosis.[8]

This arthritis prevalence increases with age and mostly seen in postmenopausal females, repetitive injury, previous fractures, rheumatoid arthritis, and sometimes it is idiopathic in origin.[9],[10],[11]

The patient presents with pain in base of thumb and also finds difficulty in holding objects due to weak gripping.[12]

When it comes to the management, the treatment options available are in the form of pain killers or surgical intervention.

Platelet-rich plasma therapy is an autologous preparation of blood component consisting of concentrated growth factors that stop catabolism of cartilage tissue and promote cellular metabolism and tissue regeneration.

Due to avascularity of chondrocytes, they have limited capacity for repair; PRP helps by enhancing anabolic effect and inhibiting the catabolic effect by reducing the MMP-3 and MMP-13.[13],[14],[15]

The abovementioned mechanism helps in the regeneration of cartilage for improving the strength of ligaments around the first carpometacarpal joint contributing to decrease the pain score numerical Rating scale (NRS) and also increase the grip strength at 1-month and 6-month follow-up.[16] Platelet Rich Plasma therapy is an efficient alternative to surgery for first carpometacarpal joint osteoarthritis.


  Conclusion Top


This case report aims in providing an insight to the role of PRP therapy for osteoarthritis of the first carpometacarpal joint in conservatively failed cases without any complications yielding results almost similar to surgical interventions. It proves efficacious in avoiding the surgical interventions needed in future for treating the same condition.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
O'Neill TW, Felson DT. Mechanism of osteoarthritis pain. Curr Osteoporos Rep 2018;16:611-6.  Back to cited text no. 1
    
2.
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: An update with relevance for clinical practice. Lancet 2011;377:2115-26.  Back to cited text no. 2
    
3.
Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Cochrane Database Syst Rev. 2015 Feb 23;2015(2):CD004631. doi: 10.1002/14651858.CD004631.  Back to cited text no. 3
    
4.
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: From basic science to clinical applications. Am J Sports Med 2009;37:2259-72.  Back to cited text no. 4
    
5.
Whitney KE, Liebowitz A, Bolia IK, Chahla J, Ravuri S, Evans TA, et al. Current perspectives on biological approaches for osteoarthritis. Ann N Y Acad Sci 2017;1410:26-43.  Back to cited text no. 5
    
6.
Sundman EA, Cole BJ, Karas V, Della Valle C, Tetreault MW, Mohammed HO, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014;42:35-41.  Back to cited text no. 6
    
7.
Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 1994;19:340-1.  Back to cited text no. 7
    
8.
Doerschuk SH, Hicks DG, Chinchilli VM, Pellegrini VD Jr. Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis. J Hand Surg Am 1999;24:496-504.  Back to cited text no. 8
    
9.
Dias R, Chandrasenan J, Rajaratnam V, Burke FD. Basal thumb arthritis. Postgrad Med J 2007;83:40-3.  Back to cited text no. 9
    
10.
Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: A long-term assessment. J Hand Surg Am 1984;9:692-9.  Back to cited text no. 10
    
11.
Pellegrini VD Jr. Osteoarthritis of the trapeziometacarpal joint: The pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am 1991;16:967-74.  Back to cited text no. 11
    
12.
Glickel SZ. Clinical assessment of the thumb trapeziometacarpal joint. Hand Clin 2001;17:185-95.  Back to cited text no. 12
    
13.
Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther 2014;16:204.  Back to cited text no. 13
    
14.
Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: Study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord 2012;13:229.  Back to cited text no. 14
    
15.
Sánchez M, Delgado D, Sánchez P, Fiz N, Azofra J, Orive G, et al. Platelet rich plasma and knee surgery. Biomed Res Int 2014;2014:890630.  Back to cited text no. 15
    
16.
Loibl M, Lang S, Dendl LM, Nerlich M, Angele P, Gehmert S, et al. Leukocyte-reduced platelet-rich plasma treatment of basal thumb arthritis: A pilot study. Biomed Res Int 2016;2016:9262909.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]



 

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