Ultrasound-guided intra-articular injection of hyaluronic acid for osteoarthritis of the carpometacarpal joint of the thumb

Abstract

Osteoarthritis (OA) is the most common disease in orthopedic practice, which is characterized by chronic pain in the joints and joint dysfunction. OA of the carpometacarpal joint (CMCJ) of the thumb is the most common type of hand osteoarthritis. The aim of the work was to evaluate the effect of ultrasound-guided intraarticular injection of hyaluronic acid (HA) for osteoarthritis of the CMCJ of the thumb (stage II–III Kellgren–Lawrence) in patients with persistent pain syndrome for 3 months and with failure of NSAIDs therapy. The study included 18 patients with stage II–III CMCJ OA who received intraarticular injection of HA drugs with a mass of 2400,000 kDa in the volume of 1.0 ml twice with an interval of 10 days. Demographic characteristics, body mass index, stage of osteoarthritis (CMCJ), severity of pain syndrome according to visual analog scale (VAS) and upper limb function assessed with the DASH questionnaire (disabilities of the arm, shoulder, and hand) were evaluated. Data was collected at the start of the study and in 1, 3 and 6 months after the first injection. DASH and VAS scores were compared using a variance analysis of repeated measurements. The non-parametric Friedman criteria was used to check the differences in proportions. The value of p<0.05 was considered statistically significant. There was a significant improvement in DASH values in 1, 3 and 6 months after injection. There were statistically significant differences between DASH values at the start of treatment and 6 months after therapy: χ²=45.7; df 3, p<0.001. There was also a significant decrease in the average VAS score during the study in 1, 3 and 6 months after the first injection. The differences in VAS score at the start of treatment and in 6 months reached statistical significance: χ²=47.1; df 3, p<0.001. Improvement occurred after 1 month after first injection and persisted throughout the entire follow-up period for 6 months. HA injections provide pain relief and improve upper limb function in patients who are resistant to analgesics and physiotherapy. A significant decrease in pain was observed as early as 1 month after the first intra-articular injection of GNC. The obtained results already allow us to recommend the use of HA drugs for CMCJ OA.